男性慢性乙型肝炎患者肝细胞脂肪变危险因素分析

摘要

Objective To analyze the difference in clinical features between male chronic hepatitis B(CHB) patients with or without hepatic steatosis and to search for the risk factors for hepatic steatosis. Methods Two hundred and nine male patients with CHB who were hospitalized for the first time and underwent liver biopsy from March 2010 to March 2013 were included in this study,and the patients were divided into two groups ac-cording to the presence or absence of hepatic steatosis;Serum lipids,uric acid,glucose,alcohol consumption, obe-sity,overweight and hepatitis B virus DNA load between the two groups were compared,and risk factors for hepat-ic steatosis were analyzed using binary logistic regression. Results Among the 209 patients,there were 121 cases (57.9%) with and 88 (42.1%) without hepatic steatosis;Uric acid,low density lipoprotein and triglyceride were (352.5±87.1) mmol/L,(2.8±0.8) mmol/L and (1.8±0.1) μmol/L,respectively,in CHB patients with hepatic steato-sis, all of which were remarkably higher than those in CHB patients without steatosis [(310.3±69.1)mmol/L,(2.2± 0.6) mmol/L and(1.2±0.7)μmol/L, respectively,P<0.01)];Obesity,overweight and low density lipoprotein were the risk factors for hepatic steatosis(P<0.01). Conclusions Obesity and hyperlipidemia, but not viral load and alco-hol consumption,are the risk factors for hepatic steatosis in male patients with CHB.%目的：比较男性慢性乙型肝炎（CHB）合并肝脂肪变患者与单纯 CHB 患者临床特征，寻找影响肝细胞脂肪变的危险因素。方法2010年3月～2013年3月期间，住院初治且有肝活检病理学检查的男性 CHB 患者209例，根据肝组织中有无脂质沉积分为 CHB 合并脂肪变组及单纯 CHB 组，比较两组患者血脂、血尿酸、血糖、饮酒、体质量指数和病毒载量情况，进行二元 Logistic 回归分析，了解肝脂肪变的危险因素。结果在209例男性 CHB 患者中，合并脂肪变121例（57.9%），单纯 CHB 88例（42.1%）；CHB 合并脂肪变患者尿酸、低密度脂蛋白和甘油三酯分别为（352.5±87.1）mmol/L、（2.8±0.8）mmol/L 和（1.8±0.1）μmol/L，均显著高于单纯 CHB 患者[（310.3±69.1） mmol/L、（2.2±0.6） mmol/L 和（1.2±0.7）μmol/L，P<0.01）]；体质量指数和低密度脂蛋白水平升高是男性 CHB 患者合并肝脂肪变的危险因素（P<0.05）。结论肥胖、血脂紊乱等代谢综合征相关表现是男性 CHB 患者肝组织脂肪变的危险因素，而饮酒或病毒载量可能不是肝脂肪变的危险因素。