慢性乙型肝炎合并非酒精性脂肪肝的临床特征分析

Characteristics and intervention strategies of chronic hepatitis B complicated with nonalcoholic fatty liver disease

目的分析慢性乙型肝炎(CHB)合并非酒精性脂肪肝(NAFLD)的特征,为预防NAFLD的发生提供干预对策。方法随机抽取2018年6月至2021年6月联勤保障部队第九〇四医院收治的CHB患者348例,根据是否患有NAFLD分为实验组(CHB合并NAFLD,n=195)和对照组(CHB,n=153),收集研究对象年龄、性别、BMI(kg/m^(2))、糖尿病病史、高血压病史、饮酒史等基本资料;收集肝功(AST、ALT、GGT、ALP、ALB)、血脂(TG、LDL-C)、空腹血糖(FBG)等血清学指标以及乙肝病毒定量(HBVDNA)等病毒学指标,采用logistic回归分析方法筛选CHB患者发生NAFLD的独立危险因素。结果研究共纳入CHB患者348例,其中合并NAFLD患者共195例(56.03%)。实验组N AFLD高发年龄段为30~45岁163(46.84%);男性发病率70.81%(131/195)显著高于女性发病率39.26%(64/195),差异具有统计学意义(χ^(2)=35.005,P<0.05);患者在年龄<30岁和30~45岁时,男性NAFLD发病率显著高于女性发病率(χ^(2)=10.625,χ^(2)=20.238,P<0.05);患者在年龄>45岁时,男性和女性NAFLD发病率差异无统计学意义(χ^(2)=2.005,P>0.05);两组高血压病史、ALT、ALP间差异无统计学意义(P>0.05)。两组年龄、性别、BMI、糖尿病病史、饮酒史、AST、TG、LDL、FBG和FBG间差异具有统计学意义(P<0.05)。logistic回归分析结果显示BMI、AST、FBG、TG升高是CHB患者发生NAFLD的独立危险因素(P<0.05)。结论CHB患者发生NAFLD的风险较高,BMI、AST、FBG、TG升高是CHB患者发生NAFLD的独立危险因素。

Objective To analyze the characteristics of chronic hepatitis B(CHB)complicated with non-alcoholic fatty liver disease(NAFLD),and to provide countermeasures for the prevention of NAFLD.Methods A total of 348 patients with CHB admitted to our hospital from June 2018 to June 2021 were randomly selected and divided into experimental group(CHB combined with NAFLD,n=195)and control group(CHB,n=153)according to whether they had NAFLD or not.Basic data such as age,sex,BMI(kg/m^(2)),history of diabetes,history of hypertension,and history of alcohol consumption were collected.Serum indexes such as liver function(AST,ALT,GGT,ALP,ALB),blood lipid(TG,ldl-c),fasting blood glucose(FBG)and virological indexes such as hepatitis B virus(HBV DNA)were collected.Results A total of 348 CHB patients were included in the study,including 195(56.03%)patients with NAFLD.The high NAFLD incidence age was between 30 and 45 years old(163 cases,46.84%).The incidence of NAFLD in male(131 cases,70.81%)was significantly higher than that in female(64 cases,39.26%)(χ^(2)=35.005,P<0.05).The incidence of NAFLD in male patients was significantly higher than that in female patients at age<30 and 30~45(χ^(2)=10.625,χ^(2)=20.238,P<0.05).There was no significant difference in the incidence rate of NAFLD between men and women at age>45 years(χ^(2)=2.005,P>0.05).There were no significant differences in the history of hypertension,ALT and ALP between the two groups(P>0.05).The differences in age,sex,BMI,history of diabetes,history of alcohol consumption,AST,TG,TG,FBG and FBG between the two groups were statistically different(P<0.05).Logistic regression analysis showed that increased BMI,AST,FBG and LDL were independent risk factors for NAFLD in CHB patients(P<0.05).Conclusions CHB with NAFLD often has glucolipid metabolic disorder,which is related to increased body mass index and AST.It is suggested that we should strengthen the health management of patients with high blood pressure,diabetes,overweight,and obesity,guide patient to balance their diet,adjust their diet structure,control their body weight and glycolipid abnormalities,adjust body fat,reduce blood pressure by drugs,and control blood sugar in a timely manner,and maintain a healthy lifestyle.