代谢综合征对慢性乙型肝炎患者显著肝纤维化的影响

吴琦琦; 马燕; 王晓波; 徐强; 王燕; 白莉

doi:10.3969/j.issn.1001-5256.2018.12.013

代谢综合征对慢性乙型肝炎患者显著肝纤维化的影响

DOI: 10.3969/j.issn.1001-5256.2018.12.013

新疆医科大学第四附属医院肝病科

基金项目:

国家自然科学基金(81560745)；

详细信息

中图分类号: R512.62;R589;R575.2
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出版历程
- 出版日期: 2018-12-20

Influence of metabolic syndrome on significant hepatic fibrosis in patients with chronic hepatitis B

Research funding:

摘要

摘要: 目的分析代谢综合征组分疾病对慢性乙型肝炎（CHB）患者显著肝纤维化的影响并探讨其危险因素。方法收集新疆医科大学第四附属医院肝病科2016年1月-2017年5月就诊的CHB患者,按照是否合并非酒精性脂肪性肝病（NAFLD）、糖脂异常分为3组。收集患者的一般资料,所有患者均进行瞬时弹性成像检测,测量身高、体质量,并计算BMI,进行肝功能、血常规、血脂、HBsAg定量、HBV DNA的检测。利用公式计算FIB-4及APRI值。符合正态分布的计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验,进一步两两比较采用Wilcoxon秩和检验。计数资料组间比较采用χ2检验。应用单因素和多因素logistic回归模型分析显著肝纤维化的影响因素。结果CHB合并NAFLD组患者脂肪衰减参数[（283. 16±38. 43） dB/m]、肝硬度值（LSM）[9. 40 （7. 50～12. 07） k Pa]值均高于CHB组[（230. 61±29. 97） dB/m、8. 60（6. 37～11. 92） k...
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 代谢综合征X
Abstract: Objective To investigate the influence of metabolic syndrome components on significant hepatic fibrosis in patients with chronic hepatitis B (CHB) and related risk factors. Methods The patients with CHB who attended Department of Hepatology in The Fourth Affiliated Hospital of Xinjiang Medical University from January 2016 to May 2017 were enrolled and divided into three groups according to the presence or absence of nonalcoholic fatty liver disease (NAFLD) or abnormal glycolipid. The patients' general information was collected, and transient elastography was performed for all patients. Body height and body weight were measured to calculate body mass index (BMI) . Liver function assessment, routine blood test, and HBsAg quantification were performed, and blood lipids and HBV DNA were measured. Fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI) were calculated according to equations. A one-way analysis of variance was used for comparison of continuous data between groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Univariate and multivariate logistic regression analyses were used to identify the influencing factors for significant hepatic fibrosis. Results The CHB-NAFLD group had significantly higher controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) than the CHB group and the CHB-abnormal glycolipid group [CAP: 283. 16 ± 38. 43 d B/m vs 230. 61 ± 29. 97 db/m/237. 82 ± 35. 98 dB/m, P < 0. 05; LSM: 9. 40 (7. 50-12. 07) k Pa vs 8. 60 (6. 37-11. 92) k Pa/8. 20 (6. 00-11. 15) kPa, P < 0. 05], and LSM increased with the increase in the severity of NAFLD (H = 7. 76, P = 0. 02) . The CHB patients with abnormal glucose and lipids had a significantly higher LSM than those with abnormal blood lipid levels alone [9. 6 (8. 22-12. 07) vs7. 5 (5. 7-9. 67) , P < 0. 05]. The multivariate logistic regression analysis showed that increasing age (odds ratio [OR]= 1. 134, 95%confidence interval [CI]: 1. 010-1. 273, P < 0. 05) , an increase in body mass index (OR = 1. 297, 95% CI: 1. 084-1. 553, P <0. 05) , a high gamma-glutamyl transpeptidase (GGT) level (OR = 1. 025, 95% CI: 1. 006-1. 045, P < 0. 05) , a low triglyceride (TG) level (OR = 0. 399, 95% CI: 0. 180-0. 882, P < 0. 05) , and a high HBsAg level (OR = 2. 205, 95% CI: 1. 159-4. 194, P < 0. 05) were independent risk factors for significant hepatic fibrosis in CHB patients. Conclusion Besides age and high HBsAg level, overweight, a high GGT level, and a relatively low TG level also increase the risk of significant hepatic fibrosis in CHB patients.
- hepatitis B, chronic /
- liver cirrhosis /
- metabolic syndrome X

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