慢性乙型肝炎患者影响肝纤维化的主要代谢因素分析

Analysis on the main metabolism factors influencing fibroscan elasticity values in chronic hepatitis B

目的探讨慢性乙型肝炎(CHB)患者影响肝纤维化(LF)的主要代谢因素。方法分析110例CHB有无代谢异常组LF的差异,找寻影响LF的主要代谢因素。结果年龄小于30岁者LF程度轻,30岁以上LF程度增加,60岁以上者LF更明显(F=2.532,P=0.033)。有糖代谢异常、胰岛素抵抗(IR)及胰岛β细胞功能减退者LF程度分别较无糖代谢异常、IR及胰岛β细胞功能减退者更重(F=4.663、5.559、-2.771,P=0.033、0.005、0.029)。有无血脂异常、血压异常、尿酸异常、脂肪肝、体质状况和代谢异常个数对肝纤维化均无显著影响(P>0.05)。Pearson相关分析显示,肝脏弹性值(LSM)与年龄、收缩压(SBP)、糖代谢状态、空腹血糖(FPG)、稳态模型胰岛素抵抗指数(HOMA-IR)呈正相关关系(r=0.324、0.200、0.229、0.202、0.287,P=0.001、0.036、0.016、0.034、0.002),与载脂蛋白A1(Apo A1)呈负相关关系(r=-0.214、0.053),与其他指标间无显著性相关关系(P>0.05)。当控制了年龄后,偏相关分析发现,LSM与体重指数、SBP、糖代谢状态、FPG、HOMA-IR呈正相关关系(r=0.287、0.275、0.225、0.222、0.239,P=0.026、0.015、0.045、0.047、0.033),与Apo A1呈负相关关系(r=-0.222,P=0.048)。多元逐步回归分析显示,年龄及HOMA-IR是LSM的独立影响因素(t=3.115、2.318,P=0.002、0.022)。结论年龄、SBP、BMI、糖代谢状态、FPG及HOMA-IR、APOA1均对CHB患者LSM有影响,年龄及HOMA-IR则是LSM的重要影响因素。

Objective To analyze the main metabolism factors that inlfuencing liver ifbrosis （LF） in chronic hepatitis B （CHB）.Methods The difference of LF between patients with or without metabolism abnormal group were analyzed by prospective cross-section research. The main metabolism factors inlfuencing LF in 110 cases with CHB were found.Results LF degree was light in patients younger than 30 years. It increased when patient＇s age older than 30 years. LF was in particular more signiifcant in patients older than 60 years （F = 2.532,P = 0.033）. Patients with glucose metabolism abnormal, insulin resistance （IR） or hemeostasis model assement of β cells （HOMA-β） decrease had in particular more obvious LF than those without it （F = 4.663, 5.559 and-2.771;P =0.033, 0.005 and 0.029）. There were no signiifcant difference between patients with or without dyslipidemia, hypertension, hyperuricacidemia, fatty liver, anthropometric parameters condition, number of metabolism abnormal （P 〉 0.05）. Pearson correlation analyses showed that liver stiffness mesurement （LSM） was positively correlated with age, systolic blood pressure （SBP）, glucose metabolism condition, fasting plasma glucose （FPG）, hemeostasis model assement of insulin resistance （HOMA-IR） （r = 0.324, 0.200, 0.229, 0.202 and 0.287;P = 0.001, 0.036, 0.016, 0.034 and 0.002）; negative correlated with Apolipoprotein A1 （ApoA1） （r =-0.214 and 0.053）, not correlated with other anthropometric and metabolic parameters. Adjusting for age, partial correlation analyses showed that LSM was positively correlated with body mass index （BMI）, SBP, glucose metabolism condition, FPG, HOMA-IR （r= 0.287,0.275, 0.225, 0.222 and 0.239;P = 0.026, 0.015, 0.045, 0.047 and 0.033）, negative correlated with ApoA1 （r =-0.222,P = 0.048）. Stepwise multiple regression analysis showed that only age and HOMA-IR were independent prognostic factors for fibroscan elasticity values （t = 3.115 and 2.318,P = 0.002 and 0.022）. Conclusions The factors which could inlfuence LSM in CHB includes age, BMI, SBP, glucose metabolism condition, FPG, HOMA-IR and ApoA1. Age and HOMA-IR are independent prognostic factors for ifbroscan elasticity values in chronic hepatitis B.