Ten Department of liver diseases, Sixth People's Hospital of Qingdao, Qingdao, Shandong, China.
Eur Rev Med Pharmacol Sci. 2018 Sep;22(17):5640-5646. doi: 10.26355/eurrev_201809_15830.
To investigate the relations between the steatosis and liver functions, inflammations, and glucolipid metabolism in chronic hepatitis B patients.
A total of 144 chronic hepatitis B patients who were admitted to our hospital from January 2015 to April 2017 were selected and divided into the steatosis group (n=73) and the non-steatosis group (n=71) according to the detection of hepatic puncture biopsy. The general information of the patients including age, sex, and body mass index (BMI) was collected, and patients' liver functions, inflammations, and glucolipid metabolism indicators were determined and compared between the chronic hepatitis patients with steatosis and without steatosis. The chronic hepatitis patients with steatosis were further divided into the normal group and the abnormal group based on the level of C-reactive protein (CRP) (8 mg/L). Besides, according to the level of aspartate aminotransferase (AST), these patients were divided into the normal liver function group (AST<40 U/L) and the abnormal liver function group (AST>40 U/L), among whom the hepatic steatosis, glucolipid metabolism, and inflammations were compared. At the same time, the chronic hepatitis B patients with steatosis were divided into Group F1, Group F2, and Group F3 based on the fatty degeneration grade, the correlations of steatosis with inflammations, glucolipid metabolism, and liver functions were analyzed. At last, the regression analyses between steatosis and the inflammation grade, glucolipid metabolism and liver function indicators were conducted for Group F1, F2, and F3, respectively.
In the chronic hepatitis B patients with steatosis, liver function indicators-alanine aminotransferase (ALT) and AST, levels of inflammatory factors-interleukin-2 (IL-2), IL-6 and CRP and glucolipid metabolism indicators-fasting blood glucose (FBG), 2h postprandial blood glucose (2h PBG), fasting insulin (FINS), triacylglycerol (TG), total cholesterol (TC), and low-density lipoprotein (LDL) were significantly higher than those without steatosis (p<0.05). The steatosis, liver functions, and glucolipid metabolism indicators were statistically different between patients in the normal inflammatory factor group and the abnormal inflammatory factor group (p<0.06). In addition, the liver function indicators (ALT and AST) and glucolipid metabolism indicators (FBG, 2h PBG, FINS, TG, TC, HDL, and LDL) in the abnormal group were statistically higher than those of normal inflammatory factor group (p<0.05). In the normal liver function group, the average fatty degeneration grade was statistically lower than that in the abnormal liver function group (p<0.05), and glucolipid metabolism indicators (FBG, 2h PBG, FINS, TG, TC, IL-2, IL-6, CRP, HDL, and LDL) were also markedly lower than those in the abnormal liver function group (p<0.05). The steatosis was positively correlated with relevant indicators, including the blood glucose indicator of FBG (r=0.509, p<0.05), liver function indicator of AST (r=0.602, p<0.05), the blood lipid indicator of TG (r=0.740, p<0.05), and the inflammatory factor of CRP (r=0.882, p<0.05), respectively. The disease course, BMI, 2h FBG, FINS, TG, TC, HDL, LDL, AST, ALT, and inflammatory factors of IL-2, IL-6, and CRP were involved in risk factors of steatosis (p<0.05).
Our data demonstrates that the steatosis is correlated with liver functions, glucolipid metabolism and inflammation level in chronic hepatitis B patients, and the foregoing indicators can affect the disease development of chronic hepatitis B patients with steatosis.
研究慢性乙型肝炎患者肝脂肪变与肝功能、炎症及糖脂代谢的关系。
选取 2015 年 1 月至 2017 年 4 月我院收治的慢性乙型肝炎患者 144 例，根据肝穿刺活检结果将其分为肝脂肪变组（n=73）和非肝脂肪变组（n=71）。收集患者的一般资料，包括年龄、性别、体质量指数（BMI）等，检测并比较两组患者的肝功能、炎症及糖脂代谢指标。将肝脂肪变患者进一步根据 C 反应蛋白（CRP）水平分为正常组和异常组（8 mg/L），根据天门冬氨酸氨基转移酶（AST）水平分为正常肝功能组（AST<40 U/L）和异常肝功能组（AST>40 U/L），比较各组患者的肝脂肪变、糖脂代谢及炎症情况。同时根据肝脂肪变程度将慢性乙型肝炎肝脂肪变患者分为 F1 组、F2 组和 F3 组，分析肝脂肪变与炎症、糖脂代谢及肝功能指标的相关性。最后对 F1、F2、F3 组分别进行回归分析，探讨肝脂肪变与炎症分级、糖脂代谢及肝功能指标的相关性。
肝脂肪变患者的肝功能指标丙氨酸氨基转移酶（ALT）、AST，炎症因子白细胞介素-2（IL-2）、IL-6、CRP 及糖脂代谢指标空腹血糖（FBG）、餐后 2 h 血糖（2h PBG）、空腹胰岛素（FINS）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）水平明显高于非肝脂肪变患者（p<0.05）。正常炎症因子组与异常炎症因子组患者的肝脂肪变、肝功能及糖脂代谢指标比较差异有统计学意义（p<0.06）。此外，异常炎症因子组的肝功能指标（ALT、AST）和糖脂代谢指标（FBG、2h PBG、FINS、TG、TC、HDL、LDL）均明显高于正常炎症因子组（p<0.05）。在正常肝功能组中，平均脂肪变性程度明显低于异常肝功能组（p<0.05），且糖脂代谢指标（FBG、2h PBG、FINS、TG、TC、IL-2、IL-6、CRP、HDL、LDL）也明显低于异常肝功能组（p<0.05）。肝脂肪变与血糖指标 FBG（r=0.509，p<0.05）、肝功能指标 AST（r=0.602，p<0.05）、血脂指标 TG（r=0.740，p<0.05）及炎症因子 CRP（r=0.882，p<0.05）等呈正相关。病程、BMI、2h FBG、FINS、TG、TC、HDL、LDL、AST、ALT 及炎症因子 IL-2、IL-6、CRP 为肝脂肪变的危险因素（p<0.05）。
本研究表明，慢性乙型肝炎患者的肝脂肪变与肝功能、糖脂代谢及炎症水平有关，上述指标可能影响慢性乙型肝炎肝脂肪变患者的病情进展。
