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慢性乙型肝炎患者合并极轻肝脏脂肪变性的临床特征及危险因素分析

马晓艳 陈云 刘嘉城 李婕 吴超

引用本文:
Citation:

慢性乙型肝炎患者合并极轻肝脏脂肪变性的临床特征及危险因素分析

DOI: 10.3969/j.issn.1001-5256.2023.01.010
基金项目: 

国家自然科学基金面上项目 (81970545);

国家自然科学基金面上项目 (82170609)

伦理学声明:本研究方案于2008年12月29日经由南京大学医学院附属鼓楼医院伦理委员会审批,批号:2008022,所纳入患者均签署知情同意书。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:马晓艳负责实施研究过程,采集整理数据,设计论文框架,起草论文,修订论文;陈云、刘嘉城参与了研究数据的获取分析解释过程,提供指导性支持;李婕、吴超参与起草或修改文章关键内容,终审论文。
详细信息
    通信作者:

    吴超,dr.wu@nju.edu.cn (ORCID: 0000-0002-1657-010X)

Clinical features and related risk factors of chronic hepatitis B patients with concomitant minimal hepatic steatosis

Research funding: 

National Natural Science Foundation of China General Project (81970545);

National Natural Science Foundation of China General Project (82170609)

More Information
  • 摘要:   目的  观察慢性乙型肝炎(CHB)患者合并极轻肝脏脂肪变性的临床指标的变化,并分析极轻脂肪变性发生的相关影响因素。  方法  纳入2018年7月—2022年3月在南京大学医学院附属鼓楼医院感染疾病科行肝穿刺活检的CHB患者共179例。依据脂肪变性程度分为无脂肪变性组(n=98)、极轻脂肪变性组(n=81)。收集人口学信息、临床资料及肝组织病理学资料,比较各观察指标在两组中的差异。符合正态分布的计量资料两组间比较采用独立样本t检验,不符合正态分布的两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用χ2检验。相关性分析采用Spearman检验。Logistic回归分析极轻脂肪变性发生的危险因素。  结果  极轻脂肪变性组中男性比例(69.1% vs 52.0%)及显著纤维化比例(43.2% vs 25.5%)较无脂肪变性组高(χ2值分别为5.390、6.234,P值均<0.05)。极轻脂肪变性组BMI[(23.61±2.95)kg/m2 vs(22.13±2.67)kg/m2]、尿酸(UA)[333.0(291.0~375.5)μmol/L vs 287.5(244.8~345.3)μmol/L]、TG[0.92(0.66~1.14)μmol/L vs 0.77(0.62~1.02)μmol/L]、肝脏脂肪受控衰减参数(CAP)[234(214~258)dB/m vs 218(201~237)dB/m]水平均高于无脂肪变性组(t=-4.150,Z=-3.620,Z=-2.224,Z=-2.867,P值均<0.05)。正常体质量组,极轻脂肪变性患者UA[(333.0±63.9)μmol/L vs(291.0±72.8)μmol/L]、HBV DNA[4.44(3.51~6.79)log10 IU/mL vs 3.42(3.00~5.03)log10 IU/mL]高于无脂肪变性患者(t=-2.395,Z=-2.474,P值均<0.05)。BMI(OR=1.223,95%CI:1.086~1.378,P=0.001)、UA(OR=1.006,95%CI:1.002~1.010,P=0.008)为CHB合并极轻脂肪变性的危险因素。UA(OR=1.007,95%CI:1.001~1.013,P=0.022)为正常体质量CHB患者合并极轻脂肪变性的危险因素。  结论  合并极轻脂肪变性的CHB患者显著纤维化比例、CAP高于无脂肪变性者。BMI、UA是CHB患者发生极轻脂肪变性的独立危险因素。尤其在正常体质量CHB患者,UA升高与极轻脂肪变性的发生关系密切。

     

  • 图  1  炎症及纤维化等级分布

    注:a,炎症等级;b,纤维化等级。

    Figure  1.  Distribution of inflammation stage and fibrosis stage

    图  2  不同BMI水平极轻脂肪变性的分布

    Figure  2.  Distribution of minimal steatosis at different BMI levels

    图  3  BMI正常组不同UA水平的患者极轻脂肪变性分布

    Figure  3.  Distribution of minimal steatosis at different UA levels in normal BMI group

    表  1  CHB患者的临床及病理特征

    Table  1.   Baseline clinical characteristics of the CHB patients

    指标 无脂肪变性组(n=98) 极轻脂肪变性组(n=81) 统计值 P
    男[例(%)] 51(52.0) 56(69.1) χ2=5.390 0.020
    年龄(岁) 38.0(31.0~48.3) 37.0(31.5~47.0) Z=-0.072 0.942
    高血压[例(%)] 2(2.0) 5(6.2) χ2=2.004 0.157
    BMI(kg/m2) 22.13±2.67 23.61±2.95 t=-4.150 <0.001
    PLT(×109/L) 169.0±47.8 165.5±48.6 t=0.732 0.465
    ALT(U/L) 22.25(14.15~34.80) 30.10(18.70~47.85) Z=-2.944 0.003
    AST(U/L) 21.25(17.45~26.60) 23.70(19.65~35.20) Z=-2.555 0.011
    ALP(U/L) 58.25(46.18~68.05) 60.90(51.20~74.05) Z=-1.616 0.106
    GGT(U/L) 15.35(11.68~22.55) 18.10(14.20~28.70) Z=-2.466 0.014
    UA(μmol/L) 287.5(244.8~345.3) 333.0(291.0~375.5) Z=-3.620 <0.001
    TG(mmol/L) 0.77(0.62~1.02) 0.92(0.66~1.14) Z=-2.224 0.026
    TC(mmol/L) 3.96±0.80 3.90±0.77 t=0.876 0.382
    FBS(mmol/L) 4.28(4.05~4.58) 4.30(4.06~4.62) Z=-0.430 0.667
    HDL(mmol/L) 1.35(1.10~1.56) 1.22(0.99~1.50) Z=-1.759 0.079
    LDL(mmol/L) 2.27(1.83~2.65) 2.15(1.83~2.67) Z=-0.032 0.975
    HBsAg(log10 IU/mL) 3.00(2.29~3.89) 3.30(2.87~4.06) Z=-1.774 0.076
    HBeAg(+)[例(%)] 29(29.6) 29(35.8) χ2=0.781 0.377
    HBV DNA(log10 IU/mL) 3.55(3.01~5.03) 4.31(3.01~7.06) Z=-1.692 0.091
    CAP(dB/m)1) 218(201~237) 234(214~258) Z=-2.867 0.004
    显著炎症[例(%)] 29(29.6) 28(34.6) χ2=0.506 0.477
    显著纤维化[例(%)] 25(25.5) 35(43.2) χ2=6.234 0.013
    注:FBS,空腹血糖。1)共102例数据参与分析,其中无脂肪变性组59例,极轻脂肪变性组43例。
    下载: 导出CSV

    表  2  不同BMI分组的基线特征

    Table  2.   Baseline clinical characteristics of the CHB patients, stratified by BMI

    指标 正常体质量组(n=112) 超重组(n=57)
    无脂肪变性组(n=69) 极轻脂肪变性组(n=43) 统计值 P 无脂肪变性组(n=19) 极轻脂肪变性组(n=38) 统计值 P
    男[例(%)] 33(47.8) 28(65.1) χ2=3.193 0.074 11(57.9) 28(73.7) χ2=1.462 < 0.001
    年龄(岁) 39.0(32.0~48.5) 37.0(29.0~47.0) Z=0.832 0.405 39.0(31.0~50.0) 36.0(32.8~48.5) Z=-0.356 0.722
    高血压[例(%)] 1(1.4) 4(9.3) χ2=3.796 0.051 1(5.3) 1(2.6) χ2=0.255 0.614
    PLT(×109/L) 161.0±44.7 164.0±48.5 t=-1.767 0.080 199.0±48.4 167.0±49.1 t=2.112 0.039
    ALT(U/L) 22.1(14.1~31.5) 26.9(18.8~45.3) Z=-1.849 0.065 24.8(16.2~55.7) 34.2(18.6~55.9) Z=-1.10 0.271
    AST(U/L) 21.3(17.4~26.0) 23.7(18.5~29.8) Z=-1.268 0.205 22.5(20.0~28.5) 23.9(19.9~41.2) Z=-1.067 0.286
    ALP(U/L) 58.2(45.6~66.9) 60.9(51.6~69.2) Z=-1.161 0.246 60.8±19.7 62.3±19.5 t=0.285 0.776
    GGT(U/L) 15.2(11.8~23.5) 16.4(14.1~21.1) Z=-1.182 0.237 18.5(12.8~23.3) 21.6(15.4~37.2) Z=-0.906 0.365
    UA(μmol/L) 291.0±72.8 333.0±63.9 t=-2.395 0.018 340.0(254.0~397.0) 340.5(297.8~394.0) Z=-0.635 0.526
    TG(mmol/L) 0.78(0.65~0.96) 0.87(0.62~1.13) Z=-1.364 0.172 1.04(0.69~1.34) 0.93(0.71~1.15) Z=-0.279 0.780
    TC(mmol/L) 3.98(3.41~4.45) 3.25(3.19~4.36) Z=0.879 0.379 4.01±0.71 4.03±0.78 t=0.901 0.371
    FBS(mmol/L) 4.22±0.39 4.29±0.44 t=-0.216 0.829 4.49(4.22~4.90) 4.33(4.03~4.66) Z=-1.168 0.243
    HDL(mmol/L) 1.40±0.36 1.24±0.32 t=1.165 0.247 1.20(1.10~1.35) 1.21(0.93~1.48) Z=-0.330 0.741
    LDL(mmol/L) 2.27(1.76~2.53) 2.06(1.73~2.54) Z=-0.835 0.404 2.61±0.61 2.30±0.49 t=1.106 0.314
    HBsAg(log10 IU/mL) 2.99±1.17 3.30±1.04 t=-1.677 0.096 3.27±1.38 3.27±1.21 t=0.369 0.714
    HBeAg(+)[例(%)] 19(27.5) 14(32.6) χ2=0.321 0.571 7(36.8) 15(39.5) χ2=0.037 0.847
    HBV DNA(log10 IU/mL) 3.42(3.00~5.03) 4.44(3.51~6.79) Z=-2.474 0.013 3.74(3.26~7.53) 4.24(2.70~7.29) Z=-0.623 0.533
    CAP(dB/m)1) 218.0(201.0~234.5) 217.0(206.0~243.5) Z=-0.570 0.569 237.0(218.0~246.0) 250.0(231.5~268.5) Z=-1.390 0.165
    显著炎症[例(%)] 18(26.1) 12(27.9) χ2=0.045 0.832 6(31.6) 16(42.1) χ2=0.592 0.442
    显著纤维化[例(%)] 20(29.0) 16(37.2) χ2=0.821 0.365 4(21.1) 19(50.0) χ2=4.410 0.036
    注:1)4组对应的例数分别为41、22、11、21。
    下载: 导出CSV

    表  3  UA与肝组织学特征相关性分析

    Table  3.   Correlation between UA and liver histological features

    组别 组织学特征 r P
    全部 炎症分级 0.004 0.969
    纤维化分级 0.063 0.575
    正常体质量组 炎症分级 -0.088 0.573
    纤维化分级 0.136 0.384
    超重组 炎症分级 0.024 0.884
    纤维化分级 -0.055 0.744
    下载: 导出CSV

    表  4  CHB合并极轻脂肪变性危险因素的Logistic回归分析

    Table  4.   Univariate and multivariate analysis of risk factors for CHB complicated with minimal steatosis

    变量 单因素 多因素
    OR (95% CI) P OR (95% CI) P
    男性 2.431(1.313~4.500) 0.005
    BMI 1.257(1.116~1.415) <0.001 1.223(1.086~1.378) 0.001
    UA 1.007(1.003~1.011) 0.001 1.006(1.002~1.010) 0.008
    TG 2.491(1.100~5.641) 0.029
    HDL 0.426(0.176~1.032) 0.059
    HBsAg 1.260(0.974~1.630) 0.078
    HBV DNA
       < 3 log10 IU/mL
      3~5 log10 IU/mL 0.650(0.302~1.400) 0.271
      ≥5 log10 IU/mL 1.318(0.586~2.964) 0.504
    下载: 导出CSV

    表  5  正常体质量组CHB合并极轻脂肪变性危险因素的Logistic回归分析

    Table  5.   Univariate and multivariate analysis of risk factors for CHB complicated with minimal steatosis in normal BMI group

    变量 单因素 多因素
    OR(95%CI) P OR(95%CI) P
    男性 2.036(0.929~4.465) 0.076
    UA 1.007(1.001~1.013) 0.022 1.007(1.001~1.013) 0.022
    HBsAg 1.363(0.942~1.972) 0.100
    HBV DNA
    <3 log10 IU/mL
    3~5 log10 IU/mL 1.583(0.534~4.695) 0.407
    ≥5 log10 IU/mL 2.833(0.909~8.834) 0.073
    下载: 导出CSV
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