慢性丙型病毒性肝炎脂肪变的临床与病理学特点

Clinical and pathological characteris-tics of steatohepatitis in patients with chronic hepatitis C virus infection

目的:利用临床资料和病例资料的回顾性分析,阐明慢性丙型肝炎患者合并脂肪肝的比例和临床病理学特点,为了解慢性丙型病毒性肝炎的脂肪变病理特征,探索新型治疗技术和方法奠定基础.方法:对于经过肝脏活检的159例慢性丙型肝炎患者的临床和病理学特点进行回顾性分析,阐明慢性丙型肝炎合并肝脏脂肪变的比例和临床、病理学特点.根据病理改变的类型和程度,分析慢性丙型肝炎患者合并脂肪肝的流行率、临床与病理学特点.计量资料应用SAS统计学软件进行分析.结果:159例慢性丙型肝炎患者中有131例患者合并肝脏脂肪变,占82.39%(131/159).对其中112例患者进行了病理改变的程度分析,轻度、中度和重度分别为29.46%(33/112)、60.71%(68/112)和9.82%(11/112);对其中131例患者进行病理类型分类,小泡型、大泡型和混合型分别为47.33%(62/131)、3.82%(5/131)和48.85%(64/131).对于慢性丙型肝炎患者合并脂肪肝进行多因素相关回归分析,结果表明慢性丙型肝炎合并脂肪肝的病理类型、病变程度与是否合并其他肝炎病毒感染、HCVRNA是否阳性、是否有输血史及年龄等因素无关,但与性别有关.男性与女性患者相比,合并肝脏脂肪变的慢性丙型肝炎女性患者以小泡型为主.而男性患者以混合型为主;女性患者以轻度和中度为主,没有重度患者,而男性患者则以中度和重度为主,总的来说,男性患者病理改变较女性患者为重.性别之间的差异有显著的统计学意义.结论:82.39%慢性丙型肝炎患者合并肝脏脂肪变,肝脏脂肪变的病理分型和病理改变程度与性别有关,女性患者脂肪肝病变较轻,男性较重.

AIM: To elucidate the clinical and pathological characteris-tics of steatohepatitis in the patients with chronic hepatitisC virus (HCV) infection.METHODS: The clinical and pathological data of 159 pa-tients with chronic HCV infection were analyzed retrospec-tively to elucidate the epidemiological rate and the charac-teristics of different pathological types and grades. Thepathological typing was clarified as microvesicular,macrovesicular and mixed. The pathological grading wasclarified as mild (less than 10%),moderate (less than 30%,but more than 10%) and severe (more than 30%). Thesignificant analysis of multiple factors was conducted byusing SAS statistic analysis software.RESULTS: The incidence of steatohepatitis in patients withchronic HCV infection was 82. 39% (131/159). The per-centages of mild,moderate and severe types ofsteatohepatitis were 29. 46% (33/112),60. 71% (68/112)and 9. 82% (11/112) respectively. The percentages ofmicrovesicular,macrovesicular and mixed types insteatohepatitis were 47. 33% (62/131),3. 82% (5/131) and48. 85% (64/131),respectively. The types and grades ofsteatohepatitis in patients with chronic HCV infection werenot significantly related with the types of hepatitis viruses,HCV RNA positivity,transfusion history and age,but thegender. Generally,the steatohepatitis in male patients is sig- nificantly severe than that of female patients.CONCLUSION: Eighty-two percent of patients with chronicHCV infection were accompanied with steatihepatitis. Thesteatohepatitis of male patients was significant severe thanthat of female patients.