慢性乙型肝炎合并脂肪肝人群疾病预后的流行病学研究

Epidemiological study of disease prognosis among chronic hepatitis B patients with fatty liver

目的:探讨慢性乙型病毒性肝炎(chronic hepatitis B,CHB)合并脂肪肝患者的疾病预后情况,为CHB合并脂肪肝的防治策略提供临床依据。方法:回顾性分析2016—2017年915例慢性乙型肝炎患者,收集相关临床信息,采用肝脏瞬时弹性成像技术测脂肪肝严重程度,比较有无合并脂肪肝的CHB患者间的乙肝病毒载量(hepatitis B virus DNA,HBV DNA)水平、肝纤维化程度等疾病进展。结果:915例CHB患者中,合并脂肪肝者447例(占总数的48.8%)。控制衰减参数(controlled attenuation parameter,CAP)值与HBV DNA水平呈负相关,脂肪肝越严重,病毒载量越低。与CHB患者相比,合并脂肪肝的CHB患者的肝纤维化程度较低(OR=0.79,95%CI:0.67~0.92,P=0.003)。CAP值与丙氨酸氨基转移酶呈现U型关联。结论:本研究发现提示合并重度脂肪肝后,CHB患者肝脏炎症严重程度加重。

Objective:The co-existence of fatty liver and chronic hepatitis B(CHB)is common among patients.The study was aimed to explore the prognosis of CHB patients complicated with fatty liver.Methods:A retrospective study of 915 patients with CHB treated in the department of infectious disease of Jiangsu Province Hospital between 2016 and 2017 was conducted.Liver steatosis assessment was performed using Fibroscan.HBV DNA viral load and the degree of liver fibrosis were compared between the two groups with or without fatty liver.Results:Among the 915 CHB patients,447 of whom were diagnosed with fatty liver(48.8%).Controlled attenuation parameter(CAP)value was negatively correlated with HBV DNA level.Compared with the simple CHB patients,CHB with fatty liver had a lower degree of liver fibrosis(OR=0.79,95%CI:0.67-0.92,P=0.003).CAP values were U-shaped correlated with alanine transaminase.Conclusion:This finding indicates that the severity of liver inflammation is aggravated in CHB patients with severe fatty liver.