非酒精性脂腑性肝病与其合并慢性乙型肝炎病毒感染的临床探讨

Clinical study of non-alcoholic fatty liver disease and its combined the chronic HBV infection

目的比较非酒精性脂肪性肝病（NAFLD）与慢性乙型肝炎病毒（HBV）感染合并NAFLD者临床资料的差异，以及探索HBV感染与肝脏脂肪变的关系。方法收集2014年6月至2016年6月住院NAFLD患者的临床资料，分为NAFLD组、HBV合并NAFLD组。比较两组患者肝功能指标（丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、y-谷氨酰转移酶）、血脂指标（总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇）、血糖、尿酸、肝纤维化程度、炎症水平分级和肝脂肪变程度的差异，分析HBV感染与肝脂肪变的关系。服从正态分布的计量资料比较用独立样本t检验，非正态分布的计量资料比较用Wilcoxon秩和检验，计数资料比较采用x2检验，肝脂肪变相关危险因素的探讨采用多项分类logistic回归分析。结果共纳入81例研究对象（NAFLD组45例、HBV合并NAFLD组36例），基线水平比较：丙氨酸氨基转移酶（t=-4．379，P〈0．01）、天冬氨酸氨基转移酶（t=3．847，P〈0．01）、y-谷氨酰转移酶（t=-2．763，P〈0．01）以及肝脏脂肪变程度（x2=20．341，P〈0．01）的差异均有统计学意义，血脂指标、血糖、尿酸、炎症水平、纤维化程度的差异均无统计学意义（P值均〉0．05）。logistic回归分析显示：HBeAg状态与肝脂肪变相关，HBVDNA载量与肝脂肪变无关。结论除HBV感染相关指标外，难以区别慢性HBV感染合并NAFLD与单纯NAFLD的差异；HBV感染与肝脏脂肪变有一定联系。

Objective to compared with clinical data between nonalcoholic fatty liver disease （NAFLD） and Chronic HBV infection with NAFLD, and to explore the relationship between HBV infection and hepatic steatosis. Methods A total of 81 patients with clinical data in the Department of Infectious Diseases in Henan Provincial People＇s Hospital from June 2013 to June 2016 were enrolled and divided into NAFLD group and HBV combined NAFLD group.Comparison of The levels of liver function （ALT, AST, ALP, GGT）, blood lipid （TC, TG, HDL, LDL）, blood glucose （GLU）, uric acid （UA）, hepatic fibrosis （S） and inflammation （G） And hepatic steatosis （F）, and to explore the relationship between HBV infection and hepatic steatosis. The independent samples t-test or Wilcoxon two -sample test was used for comparison of continuous data,and the chi-square test was used for comparison of categorical data. Multinomial Logistic regression was used to analyze The risk factors of hepatic steatosis, P 〈 0.05 was considered statistically significant. Results Atotal of 81 subjects were enrolled, with 31 in the NAFLD group and 36 in the HBV with NAFLD group. Baseline level comparison： ALT （t = -4.379, P〈0.01）, AST（t=-3.847,P〈0.01）, GGT（t=-2.763,P〈0.01） and F（x2 =20.341,P〈0.01）, There were significant difference （P 〈 0.05）; There were no significant differences in the levels of blood lipids, blood glucose, uric acid, inflammation and fibrosis, e antigen status of liver steatosis is a risk factor, hepatitis B viral load and liver steatosis has nothing to do. Conclusion In addition to HBV infection-related indicators, it is difficult to distinguish between NAFLD and NAFLD combined with H]3V differences; HBV infection and hepatic steatosis have a certain relationship.