慢性乙型病毒性肝炎合并非酒精性脂肪性肝病中医证型及相关指标分布特点

Distribution Characteristics of TCM Syndrome Types and Relevant Indicators of Chronic Hepatitis B Com-plicated with Non-alcoholic Fatty Liver Disease

目的探讨慢性乙型病毒性肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)患者中医证型及相关指标的分布特点。方法选取CHB合并NAFLD患者160例(CHB合并NAFLD组),同期纳入单纯CHB患者160例(单纯CHB组),比较两组一般情况、中医证型分布、生化指标、乙肝病毒学指标、肝脏受控衰减参数(CAP)值及肝脏硬度(LSM)值、肝活检组织学的差异。结果与单纯CHB组比较,CHB合并NAFLD组男性较多、体重指数(BMI)明显升高、中医证型分布以湿热内结证为主,差异有统计学意义(P<0.05);血清谷丙转氨酶(ALT)、谷草转氨酶(AST)水平降低,血清谷氨酰转肽酶(GGT)、总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FPG)、尿酸(UA)水平升高(P<0.05);血清乙肝病毒脱氧核糖核酸(HBVDNA)、乙肝表面抗原(HB-sAg)水平降低(P<0.05),CAP值升高(P<0.05);肝脏纤维化程度加重(P<0.05)。CAP及BMI为CHB合并NAFLD的危险因素。结论CHB合并NAFLD患者中湿热内结证较多,超重、代谢紊乱、肝组织纤维化明显。

Objective To observe the distribution characteristics of traditional Chinese medicine(TCM)syndrome types and relevant indicators of chronic hepatitis B(CHB)patients complicated with nonalcoholic fatty liver disease(NAFLD).Methods Totally 160 CHB patients complicated with NAFLD were recruited.Another 160 CHB patients were also recruited at the same observation period.The general conditions,distribution characteristics of TCM syndrome types,bi-ochemical indicators,virology indices of hepatitis B,liver controlled attenuation parameter values(CAP),liver stiffness measured(LSM),and histological results of liver biopsy were compared.Results Men were dominated among CHB patients complicated with NAFLD.Their body mass index(BMI)significantly increased,and dampness-heat internal accumulation syndrome(DHIAS)was dominated in the distribution of TCM syndrome types(P<0.05).Serum levels of alanine amin-otransferase(ALT)and aspartate aminotransferase(AST)were lower in CHB patients complicated with NAFLD than insim-ple CHB patients.Serum levels ofγ-glutamyl(GGT),total cholesterol(TC),triglyceride(TG),fasting blood glucose(FBG),and uric acid(UA)were higher in CHB patients complicated with NAFLD than in simple CHB patients(P<0.05).Serum HBVDNA and HBsAg levels in CHB patients complicated with NAFLD were lower than in simple CHB patients(P<0.05).CAP value in CHB patients complicated with NAFLD were lower than in simple CHB patients(P<0.05).The degree of liver fibrosis was severe in CHB patients complicated with NAFLD,with statistical difference as com-pared with simple CHB patients(P<0.05).CAP and BMI were risk factors for CHB patients complicated with NAFLD.Conclusion DHIAS was dominated in CHB patients complicated with NAFLD,with obvious overweight,metabolic disor-ders,and fibrosis of liver tissues.