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慢性乙型肝炎合并非酒精性脂肪性肝病的影响因素

作者：韩俊梅 1 张燕霞 1 刘赵亮 1 张妮娜 1 郭章林 1 程雁鹏 2 王素萍 2

单位：1.晋城市第三人民医院内一科山西晋城 048000 2.山西医科大学公共卫生学院流行病学教研室太原 030009

关键词：肝炎乙型慢性脂肪肝非酒精性影响因素肥胖高甘油三酯

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出版年,卷(期):页码：2017,9(2):51-55

摘要：

摘要：目的探讨慢性乙型肝炎（chronic hepatitis B，CHB）合并非酒精性脂肪性肝病（non-alcoholic
fatty liver disease，NAFLD）的影响因素。方法选取2010年6月至2015年6月于晋城市第三人民医院住
院及门诊明确诊断为CHB的初治患者323例为研究对象，依据肝胆胰彩色超声等影像学检查结果分为
CHB合并NAFLD组（107例）和单纯CHB组（216例）。记录所有患者的身高、体重并计算身体质量
指数[BMI = 体重（kg）/身高 2 （m 2 ）]，检测血清酶学指标（ALT、TBil）、脂代谢指标（LDL、TG、
UA）、空腹血糖（FBG）以及HBsAg、HBeAg、HBV DNA，分析CHB合并NAFLD的影响因素。结果
①CHB合并NAFLD患者BMI为（27.10 ± 3.07）kg/m 2 、血糖（5.96 ± 1.76）mmol/L、甘油三酯（1.75 ±
0.98）mmol/L、低密度脂蛋白（3.66 ± 1.06）mmol/L、尿酸（332.11 ± 87.07）μmol/L；单纯CHB组BMI
为（23.75 ± 2.92）kg/m 2 、血糖（5.46 ± 1.64）mmol/L、甘油三酯（1.06 ± 0.86）mmol/L、低密度脂蛋白
（2.19 ± 0.94）mmol/L、尿酸（271.19 ± 73.64）μmol/L，两组患者各指标的差异有统计学意义（P均＜
0.05）。②单因素分析显示：CHB合并NAFLD患者中，BMI ≥ 28 kg/m 2 、HBV DNA ≥ 5log 10 拷贝/ml、
高甘油三酯血症、高低密度脂蛋白血症、高尿酸血症、HBeAg阳性、男性以及年龄≥ 40岁所占比例均
高于单纯CHB患者组（P均＜ 0.05）。③多因素分析显示：肥胖、高甘油三酯、高低密度脂蛋白水平是
CHB合并NAFLD的危险因素（P均＜ 0.05），ALT和TBil水平升高并非增加CHB合并NAFLD发病风险
的危险因素（OR值分别为0.228、0.309；95%CI分别为0.110～0.476、0.148～0.645）。结论肥胖、高甘
油三酯及高低密度脂蛋白水平是影响CHB患者合并NAFLD的危险因素。

Abstract: Objective To investigate the influence factors of chronic hepatitis B (CHB) complicated with non-
alcoholic fatty liver disease (NAFLD). Methods Total of 323 patients with CHB from June 2010 to June 2015 in
our hospital were selected and divided into CHB combined with NAFLD group (107 cases) and CHB group (216
cases) according to hepatobiliary and pancreatic ultrasound. Body mass index (BMI), alanine aminotransferase
(ALT), total bilirubin (TBil), low density lipoprotein (LDL), triglyceride (TG), uric acid (UA), fasting blood-
glucose (FBG), hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) and HBV DNA levels of
all patients were recorded and the influence factors of CHB complicated with NAFLD were analyzed. Results
①BMI, the levels of blood sugar, TG, LDL and UA were (27.10 ± 3.07) kg/m 2 , (5.96 ± 1.76) mmol/L, (1.75 ±
0.98) mmol/L, (3.66 ± 1.06) mmol/L and (332.11 ± 87.07) μmol/L in CHB patients with NAFLD, respectively; and
the above indexes in patients with CHB were (23.75 ± 2.92) kg/m 2 , (5.46 ± 1.64) mmol/L, (1.06 ± 0.86) mmol/L,
(2.19 ± 0.94) mmol/L and (271.19 ± 73.64) µmol/L, respectively. The differences between the two groups were
statistically significant (P ＜ 0.05). ②Single factor analysis showed that in CHB patients with NAFLD, the ratio
of BMI ≥ 28 kg/m 2 , HBV DNA ≥ 5log 10 copies/ml, hypertriglyceridemia, hyperlipidemia, hyperuricemia,HBeAg (+), male and ≥ 40 years old were all higher than those of patients in CHB group (P ＜ 0.05). Logistic
analysis showed that obesity, high level of triglyceride and low level of density lipoprotein were the risk factors
of CHB complicated with NAFLD (P ＜ 0.05), and the increased level of ALT and TBil were not the risk
factors (OR: 0.228～0.309; 95%CI: 0.110～0.476, 0.148～0.645). Conclusion High body mass index, high
triglycerides and high LDL levels are the risk factors of CHB patients complicated with NAFLD.

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