慢性乙型肝炎合并脂肪肝人群疾病预后的流行病学研究
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1.南京医科大学公共卫生学院流行病与卫生统计学系;2.南京医科大学第一附属医院感染科

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国家自然科学青年基金项目,江苏省自然科学青年基金项目,中国博士后科学基金面上项目


Disease prognosis among chronic hepatitis B patients with hepatic steatosis
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1.Department of Epidemiology and Biostatistics,School of Public Health,Nanjing Medical University;2.Department of Infectious Disease,Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital,Nanjing

Fund Project:

National Natural Science Foundation of China, the Natural Science Foundation of Jiangsu Province, China Postdoctoral Science Foundation

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    摘要:

    目的:探讨慢性乙型病毒性肝炎(chronic hepatitis B, CHB)合并脂肪肝患者的疾病预后情况,为CHB合并脂肪肝的防治策略提供临床依据。方法:回顾性分析2016-2017年江苏省人民医院感染科门诊就诊的915例慢性乙型肝炎患者,收集相关临床信息,采用肝脏弹性成像技术检测脂肪肝严重程度,比较有无合并脂肪肝的CHB患者两组间的乙肝病毒载量(hepatitis B virus DNA, HBV DNA)水平、肝纤维化程度等疾病进展。结果:所有慢乙肝患者中,合并脂肪肝者447例(占总数的48.8%)。控制衰减参数(controlled attenuation parameter, CAP)值与HBV DNA水平呈负相关,脂肪肝越严重,病毒载量越低。与CHB患者相比,合并脂肪肝的CHB患者的肝纤维化程度较低(OR=0.79,95%CI 0.67-0.92,P=0.003)。CAP值与谷丙转氨酶(Alanine Aminotransferase, ALT)呈现U型关联。结论:本研究发现合并重度脂肪肝后,患者肝脏炎症严重程度加重。

    Abstract:

    Objective: The co-existence of fatty liver and chronic hepatitis B (CHB) is common among patients.The study was aimd to explore the prognosis of CHB patients complicated with fatty liver. Methods: A retrospective study of 915 patients with CHB treated in the department of infectious disease of Jiangsu Province Hospital between 2016 and 2017 was conducted. Liver steatosis assessment was performed using Fibroscan. A median controlled attenuation parameter (CAP) score of 222 or more dB/m was considered to have liver steatosis. Patients were divided into two groups according to the CAP value: CHB with fatty liver and simple CHB. HBV DNA viral load and the degree of liver fibrosis were compared among the two groups. Results: Among the 915 CHB patients, 447 of whom were diagnosed with hepatic steatosis (48.8%). CAP value was negatively correlated with HBV DNA level. Compared with the simple CHB patients, CHB with fatty liver had a lower degree of liver fibrosis (OR=0.79, 95%CI 0.67-0.92, P=0.003). CAP values were U-shaped correlated with Alanine transaminase (ALT). Conclusion: In this study, we found that the severity of liver inflammation was aggravated in patients with severe fatty liver.

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  • 收稿日期:2021-09-09
  • 最后修改日期:2021-11-12
  • 录用日期:2022-02-25
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