血脂状况与慢性乙型肝炎患者病情及其临床结局的相关性研究

摘要

Objective To explore the relationship between the blood lipid status and prognosis in patients with various stages of chronic hepatitis B. Methods 80 cases of chronic hepatitis B,48 cases of cirrhosis secondary to hepatitis B and 17 cases of hepatocellular carcinoma with HBsAg positive were enrolled. One-way ANOVA analy-sis was used to study the differences in age, gender,blood lipid indexes,liver function and HBV DNA levels among groups. Based on the average level of HBV DNA in all the patients (5.877 lg copies/ml) for the critical value,the pa-tients were divided into high HBV DNA group and low HBV DNA group,and the case composition,gender,age,liver function and blood lipid indexes were compared. Binary Logistic regression analysis was applied to study the risk fac-tors of hepatitis B progressing into cirrhosis and hepatocellular carcinoma. Results The difference in age, ALT, Alb, TG and CHO was statistically significant among chronic hepatitis group,cirrhosis group,and hepatocellular carcino-ma with HBsAg positive group. Compared to the chronic hepatitis B group, the age and the ALT level in the cirrhosis group and hepatocellular carcinoma with HBsAg positive group were higher and the Alb, TG, CHO were lower. Fur-thermore, only the difference in ALT between the high HBV DNA group and low HBV DNA group were statistically significant. Binary Logistic regression analysis result showed that sex (P=0.048, OR=7.673), age (P=0.007, OR=1.099), ALT (P=0.013, OR=8.343), Alb (P<0.001,OR=12.431), TG (P<0.001,OR=4.212) and CHO (P=0.001, OR=3.332) were risk factors for chronic hepatitis B progressing into cirrhosis and hepatocellular carcinoma. Conclusion With the progress of chronic hepatitis B, reducing in TG and CHO levels contributed to the progression of hepatitis B into cirrhosis and hepatocellular carcinoma. Therefore, more attention should be paid to hepatitis B patients with low levels of TG and CHO.%目的：探究不同严重程度的慢性乙型肝炎患者的血脂状况与其临床预后之间的关系。方法选择单纯慢性乙型肝炎患者80例，乙型肝炎后肝硬化患者48例，HBsAg阳性的肝细胞癌患者17例作为研究对象，采用单因素方差分析比较三组患者之间的年龄、性别、血脂指标、肝功能指标以及HBV DNA。取145例患者的HBV DNA均值即5.877 lg copies/ml为界值，将患者分为高HBV DNA组和低HBV DNA组，比较两组的病例组成、性别、年龄、肝功能指标与血脂指标。采用二分类非条件Logistic回归分析慢性乙型肝炎患者发生肝硬化、肝细胞癌的危险因素。结果单纯慢性乙型肝炎、乙型肝炎后肝硬化、HBsAg阳性的肝细胞癌三组患者的年龄、ALT、Alb、TG、CHO间的差异具有统计学意义，其中乙型肝炎后肝硬化和HBsAg阳性的肝细胞癌组的年龄、ALT比慢性乙型肝炎组高， Alb、TG、CHO比慢性乙型肝炎组低，差异均具有统计学意义。高HBV DNA组和低HBV DNA组比较，只有ALT差异具有统计学意义。二分类非条件Logistic回归分析的结果显示，性别(P=0.048，OR=7.673)、年龄(P=0.007，OR=1.099)、ALT (P=0.013，OR=8.343)、Alb (P<0.001，OR=12.431)、TG (P<0.001，OR=4.212)、CHO (P=0.001，OR=3.332)是慢性乙型肝炎发生肝硬化、肝细胞癌的危险因素。结论随着慢性乙型肝炎的进展，TG、CHO水平降低，乙型肝炎进展成肝硬化和肝癌的危险程度加大，临床上对低水平的TG、CHO患者要加强监测。