[慢性乙型肝炎合并肝脂肪变性的临床及病理特征分析]

[Analysis of clinical and pathological features of chronic hepatitis B with hepatic steatosis].

作者信息

Mi Yu-qiang, Liu Yong-gang, Xu Liang, Fan Jian-gao, Zhang Hong, Ping Lei, Shi Rui-fang

机构信息

Tianjin Infectious Diseases Hospital, Tianjin Institute of Liver Disease, Tianjin 300192, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2009 Nov;17(11):817-20.

PMID:19958639

Abstract

OBJECTIVE

To explore clinical and pathological features of chronic hepatitis B (CHB) with hepatic steatosis.

METHODS

Retrospective analysis of hepatic steatosis in patients with liver biopsy-proven CHB between January 2005 and June 2008. Detailed clinical, laboratory and pathological data of CHB patients with steatosis were compared with those in sex-, age- matched CHB patients without steatosis. Patients co-infected hepatitis C virus or HIV or suffering from liver diseases of other causes were excluded.

RESULTS

Histological hepatic steatosis was found in 33.4% of the 1263 CHB patients. The prevalence of steatosis was increased with time in the study period (20.3%, 28.2%, 32.6%, 65.4%, in trend analysis, P values less than 0.05). Body mass index, fasting plasma glucose, serum triglyceride and total cholesterol level in CHB patients with hepatic steatosis (n = 114) were significantly higher than those in 113 patients without steatosis (t values were 6.811, 2.733, 3.063, 2.340, respectively, P values less than 0.01 or 0.05). Compared to patients without steatosis, serum hepatitis B virus DNA titer in patients with steatosis was significantly lower (x2 = 6.154, P less than 0.05) and reduced sharply with the increased degree of hepatic steatosis (x2 = 4.941, P less than 0.05). There were no differences in liver biochemical test (t values were 0.744, 1.390, -0.029, -1.175, 1.393, respectively, P values more than 0.05), hepatic inflammation grade and fibrosis stage between CHB patients with and without steatosis (x2 = 1.434, 0.106, respectively, P more than 0.05), and these parameters were not associated with different degree of hepatic steatosis (x2 = 2.447, 2.911, respectively, P more than 0.05).

CONCLUSIONS

Hepatic steatosis is common in patients with CHB, and is related to metabolic disorders. Hepatic steatosis does not affect the severity of CHB. The reverse association of hepatitis B virus titer with the degree of hepatic steatosis needs further investigation.

摘要

目的

探讨合并肝脂肪变性的慢性乙型肝炎（CHB）的临床及病理特征。

方法

回顾性分析2005年1月至2008年6月间经肝活检证实为CHB且合并肝脂肪变性患者的资料。将合并肝脂肪变性的CHB患者的详细临床、实验室及病理数据与年龄、性别匹配的无肝脂肪变性的CHB患者进行比较。排除合并丙型肝炎病毒或HIV感染或患有其他原因所致肝病的患者。

结果

1263例CHB患者中，33.4%存在组织学肝脂肪变性。研究期间，脂肪变性的患病率随时间增加（趋势分析中分别为20.3%、28.2%、32.6%、65.4%，P值均小于0.05）。合并肝脂肪变性的CHB患者（n = 114）的体重指数、空腹血糖、血清甘油三酯和总胆固醇水平显著高于113例无脂肪变性的患者（t值分别为6.811、2.733、3.063、2.340，P值均小于0.01或0.05）。与无脂肪变性的患者相比，合并脂肪变性的患者血清乙肝病毒DNA载量显著降低（x² = 6.154，P小于0.05），且随着肝脂肪变性程度的增加而急剧下降（x² = 4.941，P小于0.05）。合并与未合并肝脂肪变性的CHB患者在肝生化指标（t值分别为0.744、1.390、 -0.029、 -1.175、1.393，P值均大于0.05）、肝脏炎症分级及纤维化分期方面无差异（x²分别为1.434、0.106，P均大于0.05），且这些参数与不同程度的肝脂肪变性无关（x²分别为2.447、2.911，P均大于0.05）。