Kuo Yuan-Hung, Tsai Ming-Chao, Kee Kwong-Ming, Chang Kuo-Chin, Wang Jing-Houng, Lin Chun-Yin, Lin Sheng-Che, Lu Sheng-Nan
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chang Gung University College Medicine, Taoyuan, Taiwan.
PLoS One. 2016 May 13;11(5):e0155544. doi: 10.1371/journal.pone.0155544. eCollection 2016.
This study was to evaluate the association between metabolic syndrome (MetS) and chronic virus hepatitis elders in the community. Those subjects with positive hepatitis B surface antigen (HBsAg) and/or anti-hepatitis C virus (anti-HCV) screened in the community before were invited to this study and 451 responded. All participants underwent anthropometric measurements, blood tests, ultrasound and fibroscan examinations. The cut-off of liver stiffness measurement-liver cirrhosis (LSM-LC) was 10 kPa for chronic hepatitis B (CHB) patients and 12 kPa for chronic hepatitis C (CHC) patients, respectively. Among 451 responders, 56 were excluded due to negative HBsAg or anti-HCV. Three hundreds and ninety-five subjects included 228 CHB patients, 156 CHC patients and 11 dual hepatitis patients, had a mean age of 62±12.6 years. Fifty-four (23.7%) CHB patients coexisted with MetS whereas 40 (25.6%) CHC patients also had MetS. Those patients with MetS had more LSM-LC cases than those without (20.4% vs 9.8%, p = 0.04 in CHB patients; 28.2% vs 13.5%, p = 0.037 in CHC patients, respectively). In multivariate logistic analysis, detectable viremia was reversely associated with MetS in CHB patients after adjustment for age, gender and body mass index (odds ratio (OR): 0.42; 95% confidence interval (CI): 0.18-0.99; p = 0.047). Regarding CHC patients, higher LSM level was the only factor contributed to MetS (OR: 1.1; 95% CI: 1.02-1.19; p = 0.012). In conclusion, elder CHB patients coexisted with MetS might experience an inactive virus replication but have an advanced liver fibrosis. In elder CHC patients, only higher LSM level was associated with MetS.
本研究旨在评估社区中代谢综合征（MetS）与慢性病毒性肝炎老年患者之间的关联。之前在社区中筛查出乙肝表面抗原（HBsAg）阳性和/或抗丙型肝炎病毒（抗-HCV）阳性的患者被邀请参加本研究，451人做出回应。所有参与者均接受了人体测量、血液检测、超声和肝脏硬度值测定检查。慢性乙型肝炎（CHB）患者的肝脏硬度值测定-肝硬化（LSM-LC）临界值为10千帕，慢性丙型肝炎（CHC）患者为12千帕。在451名回应者中，56人因HBsAg或抗-HCV阴性而被排除。395名受试者包括228名CHB患者、156名CHC患者和11名重叠感染患者，平均年龄为62±12.6岁。54名（23.7%）CHB患者合并MetS，而40名（25.6%）CHC患者也患有MetS。合并MetS的患者比未合并MetS的患者有更多LSM-LC病例（CHB患者中分别为20.4%对9.8%，p = 0.04；CHC患者中分别为28.2%对13.5%，p = 0.037）。在多因素逻辑分析中，在调整年龄、性别和体重指数后，可检测到的病毒血症与CHB患者的MetS呈负相关（比值比（OR）：0.42；95%置信区间（CI）：0.18 - 0.99；p = 0.047）。对于CHC患者，较高的LSM水平是导致MetS的唯一因素（OR：1.1；95% CI：1.02 - 1.19；p = 0.012）。总之，合并MetS的老年CHB患者可能病毒复制不活跃，但肝纤维化程度较高。在老年CHC患者中，只有较高的LSM水平与MetS相关。
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