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慢性乙型肝炎患者血红蛋白与肝细胞脂肪变的相关性及其临床价值
Clinical value of hemoglobin and its association with hepatocyte steatosis in chronic hepatitis B patients
文章发布日期:2017年06月07日  来源:  作者:王鹏,张志侨,吕国涛,等  点击次数:1594次  下载次数:250次

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【摘要】:目的研究慢性乙型肝炎(CHB)患者血红蛋白和肝细胞脂肪变的相关性及其临床价值。方法回顾性收集2006年1月-2014年12月在佛山市顺德区第一人民医院住院行肝穿刺活组织检查的1580例CHB患者的临床和病理资料,其中216例(1367%)患者合并肝细胞脂肪变(肝细胞脂肪变组),1364例(8633%)为非肝细胞脂肪变患者(非肝细胞脂肪变组)。按血红蛋白水平由低到高分为1组、2组和3组,对3组的临床和病理特征进行分析和比较。计量资料2组间比较采用t检验,多组间比较采用方差分析;等级资料2组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验;计数资料组间比较采用χ2 检验。两变量间相关性采用Spearman秩相关分析。采用单因素logistic回归分析和多因素逐步logistic回归分析探索肝细胞脂肪变的影响因素。结果BMI、收缩压、舒张压、尿酸、TC、LDL和HBV DNA载量在不同血红蛋白水平的组间差异有统计学意义(F值分别为12718、3024、4026、4624、38、276、28108、7358,P值均<0.05),且在1组、2组、3组间呈升高趋势。1组、2组和3组患者的肝细胞脂肪变发病率分别为7.59%、1176%和21.67%,差异有统计学意义(χ2=4423,P<0.05)。血红蛋白和肝细胞脂肪变呈正相关性(rs=0.211,P<0.001)。多因素logistic回归分析显示血红蛋白、BMI、年龄、性别、AST、TG和尿酸是CHB患者肝细胞脂肪变的独立影响因素[比值比分别为1066、1.576、1.041、0.261、0.987、1.690、1006,P值均<0.05]。BMI、LDL、TG、TC、血红蛋白、年龄、尿酸和血糖的受试者工作特征曲线下面积分别为0.852、0.701、0.694、0.689、0675、0.654、0.619和0612,其95%可信区间分别为0.811~0.893、0.662~0740、0.653~0.734、0.650~0.728、0.637~0.714、0.617~0.691、0.575~0.662和0.569~0.655(P值均<0.01)。结论血红蛋白高的CHB患者更容易合并肝细胞脂肪变,血红蛋白可能是CHB患者肝细胞脂肪变的独立影响因素,高血红蛋白对于肝细胞脂肪变具有一定的预测价值,值得进一步研究。
【Abstract】:ObjectiveTo investigate the clinical value of hemoglobin and its association with hepatocyte steatosis in chronic hepatitis B (CHB) patients. MethodsA retrospective analysis was performed for the clinical and pathological data of 1580 CHB patients who were hospitalized in The First People′s Hospital of Shunde from January 2006 to December 2014 and underwent liver biopsy, among whom 216 (13.67%) had hepatocyte steatosis (hepatocyte steatosis group) and 1364 had no hepatocyte steatosis (non-hepatocyte steatosis group). The patients were divided into groups 1, 2, and 3 according to hemoglobin level, and the clinical and pathological features were analyzed and compared between the three groups. The t-test was used for comparison of continuous data between group; a one-way analysis of variance was used for comparision between multiple groups. The Mann-Whitney U test was used for ranked data between groups. The Kruskal-wallis H test was used for ranked data between multiple groups; the chi-square test was used for comparison of categorical data between groups. Spearman correlation analysis was also performed to determine the correlation between two variables. Univariate logistic regression analysis and multivariate stepwise regression analysis were used to identify the influencing factors for hepatocyte steatosis. ResultsBody mass index (BMI), systolic pressure, diastolic pressure, uric acid, total cholesterol, low-density lipoprotein, and HBV DNA load increased with the increase in hemoglobin level (F=12718,3024,4026,4624,38276,28108,7358, all P<0.05). The incidence rates of hepatocyte steatosis in groups 1, 2, and 3 were 7.59%, 1176%,and 21.67%, respectively (χ2=44.23, P<0.05). Hemoglobin was positively correlated with hepatic steatosis (rs=0.211, P<0001). The multivariate logistic regression analysis showed that hemoglobin (odds ratio [OR]=1.066, P<0.05), BMI (OR=1576, P<005), age (OR=1.041, P<0.05), sex (OR=0261, P<005), aspartate aminotransferase (OR=0.987, P<0.05), triglyceride (OR=1.690, P<0.05), and uric acid (OR=1006, P<005) were independent influencing factors for hepatocyte steatosis in CHB patients. The area under the receiver operating characteristic curve was 0.852 (95% confidence interval [CI]: 0.811-0.893, P<0.01) for BMI, 0.701 (95%CI: 0.662-0.740, P<001) for low-density lipoprotein, 0.694 (95%CI: 0.653-0.734, P<0.01) for triglyceride, 0.689 (95%CI: 0.650-0.728, P<001) for total cholesterol, 0.675 (95%CI: 0.637-0.714, P<0.01) for hemoglobin, 0.654 (95%CI: 0.617-0.691, P<0.01) for age, 0.619 (95%CI: 0.575-0.662, P<0.01) for uric acid, and 0.612 (95%CI: 0.569-0655, P<0.01) for blood glucose. ConclusionCHB patients with a high hemoglobin level tend to develop hepatocyte steatosis, and hemoglobin may be an independent influencing factor for hepatocyte steatosis in CHB patients. A high hemoglobin level has a certain value in predicting hepatocyte steatosis and awaits further research.
【关键字】:肝炎, 乙型, 慢性; 血红蛋白类; 脂肪肝; 回归分析
【Key words】:hepatitis B, chronic; hemoglobins;fatty liver;regression analysis
【引证本文】:王鹏, 张志侨, 吕国涛, 等. 慢性乙型肝炎患者血红蛋白与肝细胞脂肪变的相关性及其临床价值[J]. 临床肝胆病杂志, 2017, 33(7): 1274-1279.

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