CAJ | 학술논문

目的探讨老年慢性乙型肝炎合并肝脂肪变患者的临床特征及病理特点. 方法回顾性分析2011年6月至2012年6月我院经肝组织活检确诊的慢性乙型肝炎合并肝脂肪变老年患者(老年组)223例,并随机选取同期非老年慢性乙型肝炎合并肝脂肪变患者(对照组)220例作为对照,比较两组病例的临床特点和肝组织学改变. 结果与对照组比较,老年组患者并存2型糖尿病、高血压、冠心病比率增高(P＜0.01),代谢综合征患病率也增高(P＜0.05),而高脂血症、肥胖的比例则降低(P＜0.01).体质指数、三酰甘油、乙型肝炎病毒脱氧核糖核酸(HBV-DNA)检测水平均低于对照组(P＜0.01).老年组慢性乙型肝炎轻度的比率较对照组增多(P＜0.05).肝组织病理学检查提示老年组炎症级别＜G2、纤维化程度＞S2的比例增多(P＜0.05),而免疫组化HBcAg阳性率相对减少(P＜0.05). 结论老年慢性乙型肝炎合并肝脂肪变患者肝功能损害较轻,肝组织活检炎症级别较轻,但肝纤维化程度偏重,提示肝脏损害相对进展较慢.慢性乙型肝炎合并肝脂肪患者在老年阶段是否更容易合并代谢综合征、高血压、糖尿病、冠心病等,仍需更多证据进一步验证.乙型肝炎病毒体内复制滴度与年龄可能呈负相关.
목적 탐토노년만성을형간염합병간지방변환자적림상특정급병리특점. 방법 회고성분석2011년6월지2012년6월아원경간조직활검학진적만성을형간염합병간지방변노년환자(노년조)223례,병수궤선취동기비노년만성을형간염합병간지방변환자(대조조)220례작위대조,비교량조병례적림상특점화간조직학개변. 결과 여대조조비교,노년조환자병존2형당뇨병、고혈압、관심병비솔증고(P＜0.01),대사종합정환병솔야증고(P＜0.05),이고지혈증、비반적비례칙강저(P＜0.01).체질지수、삼선감유、을형간염병독탈양핵당핵산(HBV-DNA)검측수평균저우대조조(P＜0.01).노년조만성을형간염경도적비솔교대조조증다(P＜0.05).간조직병이학검사제시노년조염증급별＜G2、섬유화정도＞S2적비례증다(P＜0.05),이면역조화HBcAg양성솔상대감소(P＜0.05). 결론 노년만성을형간염합병간지방변환자간공능손해교경,간조직활검염증급별교경,단간섬유화정도편중,제시간장손해상대진전교만.만성을형간염합병간지방환자재노년계단시부경용역합병대사종합정、고혈압、당뇨병、관심병등,잉수경다증거진일보험증.을형간염병독체내복제적도여년령가능정부상관.
Objective To explore the clinical and pathological characters of chronic hepatitis B (CHB) in combination with hepatic steatosis in the elderly.Methods Totally 223 elderly patients with CHB and hepatic steatosis diagnosed by liver biopsy were retrospectively analyzed and 220 nonelderly patients with CHB and hepatic steatosis were randomly selected as control group.Clinical and pathological features and change in liver histology were compared between the two groups.Results The incidences of hypertension,coronary heart disease,type 2 diabetes mellitus and metabolic syndrome were increased in elderly groups (all P＜0.01 or 0.05),while the proportion of patients with hyperlipemia and obesity were decreased as compared with non-elderly group (both P＜0.01).The levels of body mass index,serum triglyceride and HBV-DNA were lower in elderly group than in non-elderly group (all P＜0.01).The ratio of mild degree of CHB was elevated in elderly group as compared with non-elderly group (P＜0.05).Liver histopathological examination showed that the proportion of patients with the inflammation grade less than G2 and fibrotic stages exceeding S2 were increased,while the positive rate of HBcAg by immunohistochemistry was reduced in elderly group as compared with non-elderly group (both P＜0.05).Conclusions The degree of inflammatory liver injury and inflammation grade are slighter,but the fibrotic stage is more serious in elderly patient with CHB and hepatic steatosis,which indicating a slower progress of liver injury.It is still to be investigated whether metabolic syndrome,hypertension,coronary heart disease and type 2 diabetes mellitus are easily complicated in elderly patient with CHB and hepatic steatosis.The serum hepatitis B virus DNA replication may be negatively correlated with ageing.