CAJ | 학술논문

目的：探讨影响慢性丙型病毒性肝炎(CHC)患者合并肝脂肪变相关因素及其临床病理特征。方法选取本院2011年6月至2013年6月收治的148例CHC患者为研究对象，根据患者是否合并肝脂肪变将其分为CHC无肝脂肪变组82例和CHC合并肝脂肪变组66例，分析两组患者临床资料、生化指标、丙型肝炎病毒(HCV)水平与CHC合并肝脂肪变的相关性及两组患者的肝组织学特征。结果两组患者的性别构成比、年龄、病程等基线资料比较差异均无统计学意义(P>0.05)，而体质指数(BMI)及腰臀比(WHR)比较则差异具有统计学意义(P<0.05)。肝脂肪变组患者空腹血糖(FBC)、糖化血糖蛋白(HAblc)、总胆固醇(TC)、甘油三脂(TG）、低密度蛋白(LDL-C)水平显著高于无肝脂肪变组，而高密度蛋白（HDL-C)则低于无肝脂肪变组，差异均有统计学意义(P<0.05)。两组谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)、碱性磷酸酶(ALP)以及总胆红素(STB)比较差异均无统计学意义(P>0.05)。两组患者抗-HCV IgG阳性及HCV RNA阳性率比较差异均无统计学意义(P>0.05)。经Logistic多因素分析显示，WHR、FBC、TC、TG是CHC患者合并肝脂肪变独立危险因素。肝脂肪变组与无脂肪变组相比，脂肪变性程度、炎症活动度分级及纤维化分期比较差异具有统计学意义(P<0.05)。结论 CHC患者合并肝脂肪变与BMI、WHR及糖脂代谢紊乱密切相关，而与HCV无关。临床针对上述影响因素对症治疗可有效预防及治疗CHC肝脂肪变。
목적：탐토영향만성병형병독성간염(CHC)환자합병간지방변상관인소급기림상병리특정。방법선취본원2011년6월지2013년6월수치적148례CHC환자위연구대상，근거환자시부합병간지방변장기분위CHC무간지방변조82례화CHC합병간지방변조66례，분석량조환자림상자료、생화지표、병형간염병독(HCV)수평여CHC합병간지방변적상관성급량조환자적간조직학특정。결과량조환자적성별구성비、년령、병정등기선자료비교차이균무통계학의의(P>0.05)，이체질지수(BMI)급요둔비(WHR)비교칙차이구유통계학의의(P<0.05)。간지방변조환자공복혈당(FBC)、당화혈당단백(HAblc)、총담고순(TC)、감유삼지(TG）、저밀도단백(LDL-C)수평현저고우무간지방변조，이고밀도단백（HDL-C)칙저우무간지방변조，차이균유통계학의의(P<0.05)。량조곡병전안매(ALT)、곡초전안매(AST)、γ-곡안선전태매(γ-GT)、감성린산매(ALP)이급총담홍소(STB)비교차이균무통계학의의(P>0.05)。량조환자항-HCV IgG양성급HCV RNA양성솔비교차이균무통계학의의(P>0.05)。경Logistic다인소분석현시，WHR、FBC、TC、TG시CHC환자합병간지방변독립위험인소。간지방변조여무지방변조상비，지방변성정도、염증활동도분급급섬유화분기비교차이구유통계학의의(P<0.05)。결론 CHC환자합병간지방변여BMI、WHR급당지대사문란밀절상관，이여HCV무관。림상침대상술영향인소대증치료가유효예방급치료CHC간지방변。
Objective To investigate the associated factors and pathological features of chronic hepatitis C (CHC) patients with hepatic steatosis. Methods A total of 148 patients with CHC from June 2011 to June 2013 were divided into CHC without steatosis group (group A, n=82) and CHC complicated with hepatic steatosis group (group B, n=66). The clinical data, biochemical parameters, the levels of HCV viral, liver steatosis CHC concurrent correla-tions and two liver histological features of two groups were analyzed. Results The sex ratio, age, duration and other baseline data showed no statistically significant difference between the two groups (P>0.05), while the body mass in-dex (BMI) and waist-hip ratio (WHR) were significantly different (P<0.05). The levels of fasting blood glucose (FBC), blood glucose glycated protein (HAblc), total cholesterol (TC), triglyceride (TG), low density protein (LDL-C) of group B were significantly higher than those of group A, while high-density protein (HDL-C) was significantly low-er. The differences were statistically significant (P<0.05). The two groups showed no significant difference in alanine aminotransferase (ALT), aspartate aminotransferase (AST),γ-glutamyl peptidase (γ-GT), alkaline phosphatase (ALP) and total bilirubin (STB), and also in the rates of anti-HCV IgG and HCV RNA positive (P>0.05). Logistic multivari-ate analysis showed that WHR, FBC, TC, TG were the risk factors for of CHC patients complicated with steatosis. Statsitically significant difference was found between the two groups in fatty degeneration, inflammatory activity grade and fibrosis stage (P<0.05). Conclusion The hepatic steatosis of CHC patients are closely related to levels of BMI, WHR and lipid disorders, but unrelated to HCV. Clinical response to these factors for symptomatic treatment can be effective in preventing and treating CHC complicated with hepatic steatosis.