非酒精性脂肪性肝病临床和病理特点及进展期纤维化危险因素性别差异的对比研究

Comparative study of clinicopathological features,and risk factors of advanced fibrosis between genders with non-alcoholic fatty liver disease

目的对比研究男性及女性非酒精脂肪性肝病(NAFLD)临床、病理及进展期纤维化危险因素的异同。方法回顾性纳入肝活组织检查明确诊断NAFLD患者267例,分为男、女两组,对比两组临床及病理指标的差异,计量资料符合正态分布、两组间比较采用独立样本t检验,非正态分布采用非参数检验。分类资料以百分数表示,组间比较采用χ2检验。危险因素采用logistic回归分析。结果男性NAFLD患者发病年龄显著低于女性患者(P<0.01)。男、女两组在人体质量指数、患2型糖尿病比率间差异无统计学意义(P>0.05)。生物化学指标:男性患者丙氨酸转氨酶、白蛋白、总胆红素及尿酸水平显著高于女性患者(P<0.01)。肝脏病理学:男性患者气球样变比例显著低于女性患者(P<0.01),而脂肪性肝炎评分,非酒精性脂肪性肝炎(52.0%比61.5%,P=0.283)及进展期肝纤维化比例(14.3%比17.8%,P=0.162),两组间差异均无统计学意义。血小板减低为进展期肝纤维化的共同独立危险因素(OR=0.984,95%CI:0.978~0.989,P<0.01),2型糖尿病仅为男性进展期肝纤维化的独立危险因素(OR=6.557,95%CI:1.667~25.782,P<0.01)。天冬氨酸转氨酶升高仅为女性进展期肝纤维化的独立危险因素(OR=1.016,95%CI:1.003~1.028,P=0.012)。结论NAFLD患者在不同性别之间临床及病理存在一定差异,血小板是男性及女性进展期肝纤维化的共同预测指标,男性患2型糖尿病,女性天冬氨酸转氨酶升高可分别作为进展期肝纤维化的独立危险因素。

Objective To comparatively study the similarities and differences between the clinical,pathological,and risk factors of advanced fibrosis in men and women with non-alcoholic fatty liver disease(NAFLD).Methods 267 patients with NAFLD diagnosed by liver biopsy were retrospectively included,and were divided into male and female groups.The difference of clinical and pathological indexes were compared between the two groups.The measurement data were in accordance with normal distribution.The comparison between the two groups was performed by independent sample t-test.The non-parametric test was used for non-normal distribution.The classification data were expressed as a percentage,and the chi-square test was used for comparison between groups.Logistic regression analysis was used to analyze the risk factors.Results The age of onset of NAFLD was significantly lower in male than female patients(P<0.01).There was no statistically significant difference between the male and female groups in terms of body mass index and the prevalence of type 2 diabetes(P>0.05).Biochemical index:The levels of alanine aminotransferase,albumin,total bilirubin and uric acid were significantly higher in male than female patients(P<0.01).Liver pathology:The proportion of ballooning degeneration was significantly lower in male than female patients(P<0.01).There was not statistically significant difference between the two groups in the proportion of steatohepatitis score,non-alcoholic steatohepatitis(52.0%vs.61.5%,P=0.283)and advanced liver fibrosis(14.3%vs.17.8%,P=0.162).Thrombocytopenia was a common independent risk factor for advanced stage liver fibrosis(OR=0.984,0.978~0.989,P<0.01).Type 2 diabetes was only an independent risk factor for advanced stage liver fibrosis in men(OR=6.557,1.667~25.782,P<0.01).Elevated AST was only an independent risk factor for advanced stage liver fibrosis in women(OR=1.016,1.003~1.028,P=0.012).Conclusion In NAFLD patients,there are some clinical and pathological differences between genders.Platelets are a common predictor of advanced liver fibrosis in men and women.Type 2 diabetes in men and elevated aspartate aminotransferase in women can be regarded as independent risk factors for advanced liver fibrosis.