慢性乙型肝炎合并非酒精性脂肪性肝病的影响因素分析

Analysis of influencing factors of chronic hepatitis B complicated with nonalcoholic fatty liver disease

目的:探讨慢性乙型肝炎合并非酒精性脂肪性肝病的影响因素,为高危人群的筛查及临床治疗提供一定的参考依据。方法:采用病例对照研究,严格按照纳入及排除标准,选取2015年1月~2018年1月于华北理工大学附属医院及唐山传染病医院住院明确诊断为慢性乙型肝炎(chronic hepatitis B,CHB)合并非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)的初治患者133例为病例组,选取同期住院明确诊断为CHB的初治患者139例为对照组。对两组临床资料、初次实验室检查及影像学检查结果进行比较,分析慢性乙型肝炎合并非酒精性脂肪性肝病的影响因素。结果:病例组体质指数(BMI)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷酰转肽酶(GGT)、空腹血糖(FBG)、甘油三酯(TG)、受控衰减参数(CAP)明显高于对照组,差异具有统计学意义(P<0.05);对照组高密度脂蛋白胆固醇(HDL-C)、乙肝病毒核心抗体(HBcAb)、Ⅲ型前胶原氨基末端肽、Ⅳ型胶原、层黏蛋白、肝脏硬度值(LSM)高于病例组,差异具有统计学意义(P<0.05);病例组更易合并相关并发症,差异具有统计学意义(P=0.01)。单因素分析结果表明病例组中BMI≥25 kg/m^2、GGT>45 U/L、Ⅳ型胶原≤140 ng/mL、层黏蛋白≤140 ng/mL、CAP≥283 dB/m、高血糖、高甘油三脂血症患者的比例明显高于对照组,差异具有统计学意义(P均<0.05);二元Logistic回归分析显示GGT、FBG、BMI、层黏蛋白、CAP是预测慢性乙型肝炎合并非酒精性脂肪性肝病的有效指标。结论:GGT、BMI、FBG、层黏蛋白及CAP是CHB合并NAFLD的影响因素。NAFLD的发生与肥胖、高血糖、高甘油三脂血症密切相关,CHB合并NAFLD时HBcAb及肝纤维指标降低,机制尚不明确。

Objective: To investigate the influencing factors of chronic hepatitis B with nonalcoholic fatty liver disease, and to provide a reference for screening and clinical treatment of high-risk groups. Methods: A case-control study was conducted. According to the inclusion and exclusion criteria, the hospital was selected from the Affiliated Hospital of North China University of Technology and Tangshan Infectious Disease Hospital from January 2015 to January 2018 to confirm the diagnosis of chronic hepatitis B(CHB). A total of 133 patients with nonalcoholic fatty liver disease(NAFLD) were enrolled in the case group. A total of 139 patients who were diagnosed with CHB in the same period were selected as the control group. The clinical data, initial laboratory examination and imaging findings of the two groups of patients were compared to analyze the influencing factors of chronic hepatitis B combined with nonalcoholic fatty liver disease. Results: Case group BMI(body mass index), ALT(alanine aminotransferase), AST(aspartate aminotransferase), GGT(glutamyl transpeptidase), FBG(fasting blood glucose), TG(triglyceride), CAP(controlled attenuation The parameters were significantly higher than the control group, the difference was statistically significant(P<0.05);the control group HDL-C(high-density lipoprotein cholesterol), HBcAb(hepatitis B virus core antibody), type Ⅲ procollagen amino terminal peptide, type Ⅳ Collagen, laminin, LSM(liver hardness value) was higher than the case group, the difference was statistically significant(P<0.05);the case group was more likely to be associated with complications, the difference was statistically significant(P=0.01). Univariate analysis showed that patients in the case group had BMI ≥ 25 kg/m^2, GGT>45 U/L, type IV collagen ≤140 ng/mL, laminin ≤140 ng/mL, CAP≥283 dB/m, hyperglycemia, high glycerol The proportion of patients with lipemia was significantly higher than that of the control group, the difference was statistically significant(P<0.05);3 binary logistic regression analysis showed that GGT, FBG, BMI, laminin, CAP were predictive of chronic hepatitis B combined with non-An effective indicator of alcoholic fatty liver disease. Conclusion: 1 GGT, BMI, FBG, laminin and CAP are the influencing factors of CHB combined with NAFLD. The occurrence of 2 NAFLD is closely related to obesity, hyperglycemia and hypertriglyceridemia. The HBcAb and liver fibrosis indexes are decreased when CHB combined with NAFLD, and the mechanism is still unclear.