合并慢性乙型肝炎对代谢相关性脂肪肝患者肾脏功能的影响及相关因素分析

Effect of metabolism-related fatty liver diseases combined with chronic Hepatitis B on renal function and its related factors

目的探讨代谢相关性脂肪性肝病(MAFLD)合并慢性乙型病毒性肝炎(CHB)患者的肾脏功能状况,并对影响肾小球滤过率(eGFR)的相关因素进行分析。方法分别收集MAFLD组(n=141)和CHB-MAFLD组(n=144)患者的肝脏生化、肾脏生化等临床资料,利用eGFR对两组患者的肾脏功能进行评价,采用多因素logistic回归分析探讨肾功能受损的影响因素。结果在符合纳入标准和排除标准的285例患者中,与MAFLD组对比,CHB-MAFLD组三酰甘油(TG)、总胆固醇(TC)、谷氨酰转肽酶(GGT)、血肌酐(SCr)、eGFR、大量饮酒史之间的差异有统计学意义(P<0.05);CHB-MAFLD组出现SCr异常升高(16.67%vs 3.55%,χ^(2)=13.418,P<0.001)及肾功能受损(40.97%vs 12.77%,χ^(2)=28.745,P<0.001)的比例明显高于MAFLD组;多因素logistic回归分析提示性别、年龄、尿酸、合并糖尿病、合并高血压、合并CHB是影响患者肾功能的独立影响因素。结论CHB-MAFLD患者存在亚临床型肾功能受损,可能比单纯MAFLD患者更易发生、发展早期肾功能受损。对于CHB-MAFLD患者,更应严格控制相关危险因素,预防慢性肾病的发生。

Objective To investigate the renal function of patients with metabolism-related fatty liver disease(MAFLD)complicated with chronic viral Hepatitis B(CHB),and to analyze the correlated factors affecting glomerular filtration rate(eGFR).Methods The clinical data of liver and renal functions were collected from patients in MAFLD group(n=141)and CHB-MAFLD group(n=144).And eGFR was used to evaluate the renal function of patients in the two groups.Multivariate logistic regression analysis was used to investigate the influencing factors of renal function injury.Results Among 285 patients who met the inclusion criteria,compared with the MAFLD group,there were significant differences in triglyceride(TG),total cholesterol(TC),glutamyl transpeptidase(GGT),serum creatinine(SCr),eGFR,and history of heavy drinking in the CHB-MAFLD group(P<0.05).The proportion of abnormally elevated SCr(16.67%vs.3.55%,χ^(2)=13.418,P<0.001)and impaired renal function(40.97%vs.12.77%,χ^(2)=28.745,P<0.001)was significantly higher in the CHB-MAFLD group than in the MAFLD group.Multivariate logistic regression analysis suggested that sex,age,uric acid,diabetes,hypertension,and CHB were independent factors affecting renal function.Conclusion CHB-MAFLD patients have subclinical renal impairment,and they may be more likely to develop early renal injury than MAFLD patients alone.Therefore,for CHB-MAFLD patients,it is more necessary to strictly control the relevant risk factors to prevent the occurrence of chronic kidney disease.