CAJ | 학술논문

目的研究HBeAg阴性慢性乙型肝炎(CHB)合并肝脂肪变患者的临床和病理关系,探讨预测此类患者肝组织炎性反应和纤维化的指标.方法分别收集经临床与病理检查确诊的HBeAg阴性CHB合并和不合并肝脂肪变患者56例和60例,分别研究并比较其空腹血糖(FBG)、空腹血胰岛素(FINS)、三酰甘油(TG)、胆固醇(TC)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、白蛋白(Alb)、球蛋白(Glb)、胰岛素抵抗指数(HOMA-IR)、HBV DNA水平、体重指数(BMI),并就上述指标与肝组织脂肪变、炎性反应和纤维化的关系进行统计学分析.结果与HBeAg阴性CHB不合并肝脂肪变者相比,合并肝脂肪变患者BMI、FBG、FINS、TG、TC、GGT、ALP、Glb和HOMA-IR明显增高(P值均<0.05),HBV DNA、AST、ALT、Alb明显降低(P值均<0.05),此外炎性反应程度和纤维化程度亦明显增强.可预测HBeAg阴性CHB者是否存在肝脂肪变的参数有BMI,FBG、FINS、TG、TC、GGT和HOMA-IR(P值均<0.05).可预测HBeAg阴性CHB合并肝脂肪变者肝组织是否存在炎性反应的参数有ALT、AST、Glb和HBVDNA(P值均<0.05),可预测其是否存在肝组织纤维化的参数有ALT,AST、Alb、Glb和HBV DNA(P值均<0.05).结论肝脂肪变在HBeAg阴性CHB患者中较常见,其肝组织脂肪变与BMI、FBG、FINS、TG、TC、GGT和HOMA-IR有关.此类患者除肝脂肪变明显增加外,肝组织炎性反应和纤维化程度亦明显加重.
목적 연구HBeAg음성만성을형간염(CHB)합병간지방변환자적림상화병리관계,탐토예측차류환자간조직염성반응화섬유화적지표.방법 분별수집경림상여병리검사학진적HBeAg음성CHB합병화불합병간지방변환자56례화60례,분별연구병비교기공복혈당(FBG)、공복혈이도소(FINS)、삼선감유(TG)、담고순(TC)、병안산전안매(ALT)、천동안산전안매(AST)、곡안선전태매(GGT)、감성린산매(ALP)、백단백(Alb)、구단백(Glb)、이도소저항지수(HOMA-IR)、HBV DNA수평、체중지수(BMI),병취상술지표여간조직지방변、염성반응화섬유화적관계진행통계학분석.결과 여HBeAg음성CHB불합병간지방변자상비,합병간지방변환자BMI、FBG、FINS、TG、TC、GGT、ALP、Glb화HOMA-IR명현증고(P치균<0.05),HBV DNA、AST、ALT、Alb명현강저(P치균<0.05),차외염성반응정도화섬유화정도역명현증강.가예측HBeAg음성CHB자시부존재간지방변적삼수유BMI,FBG、FINS、TG、TC、GGT화HOMA-IR(P치균<0.05).가예측HBeAg음성CHB합병간지방변자간조직시부존재염성반응적삼수유ALT、AST、Glb화HBVDNA(P치균<0.05),가예측기시부존재간조직섬유화적삼수유ALT,AST、Alb、Glb화HBV DNA(P치균<0.05).결론 간지방변재HBeAg음성CHB환자중교상견,기간조직지방변여BMI、FBG、FINS、TG、TC、GGT화HOMA-IR유관.차류환자제간지방변명현증가외,간조직염성반응화섬유화정도역명현가중.
Objective To investigate the relationship between clinical presentation and pathological characteristics in HBeAg negative chronic hepatitis B(CHB) patients with steatosis, and to find out the predictors of hepatic inflammation and fibrosis. Methods HgeAg negative CHB patients with (n=56) or without (n=60) steatosis confirmed clinically and pathologically were enrolled in the study. All patients were examined for fasting blood glucose(FBG), fasting insulin (FINS), triglyceride (TG), cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyhransferase (GGT), alkaline phosphatase (ALP) albumin (Alb), globulin(Glb), homeostatic model assessment of insulin resistance (HOMA-IR), HBV-DNA and body mass index(BMI). The association of above parameters with hepatic inflammation, fibrosis and fatty deposition were analyzed statistically. Results It was demonstrated that BMI, FBG, FINS, TG, TC, GGT, ALP , Glb and HOMA-IR were significantly higher in HBeAg negative CHB patients with steatosis than those without steatosis (P<0.05). Whereas the levels of HBV-DNA, Alb, ALT and AST were significantly lower in HBeAg negative CHB patients with steatosis compared with those without steatosis (P<0.05). The hepatic inflammation and fibrosis were aggravated in patients with steatosis. It was implicated that BMI,FBG, FINS, TG, TC, GGT and HOMA-IR(all P values 0.05) were significant predictors for hepatic steatosis, while ALT, AST, Glb and HBV-DNA(all P values <0.05) were significant predictors for hepatic inflammation. And the predictors for hepatic fibrosis were ALT, AST, Alb, Glb and HBV-DNA(all P values <0.05). Conclusions Hepatic steatosis is common in HBeAg negative CHB patients which is positively associated with parameters including BMI, FBG, FINS, TG, TC, GGT, ALP and HOMA-IR. Besides steatosis, the hepatic inflammation and fibrosis are also aggravated in these patients.