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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 256 -261. doi: 10.3877/cma.j.issn.1674-1358.2018.03.011

所属专题： 文献；

临床论著

HBeAg阳性慢性乙型肝炎合并非酒精性脂肪肝患者的临床与病理学特征
谢放1, 孟庆华2, 侯维2, 陈德喜1,†()   
  1. 1. 100069　北京，首都医科大学附属北京佑安医院；北京市肝病研究所
    2. 100069　北京，首都医科大学附属北京佑安医院
  • 收稿日期:2017-10-24 出版日期:2018-06-15
  • 通信作者: 陈德喜
  • 基金资助:
    首都医科大学附属北京佑安医院院内课题(No. BJYAH2016YN02); 北京市肝病研究所基金(No. BJIH-2018-3-6); 北京市肝病研究所，北京市属医学科研院所公益发展改革试点项目(No.京医研2016-2)

Clinical and pathological on HBeAg-positive patients with chronic hepatitis B complicated with nonalcoholic fatty liver disease

Fang Xie1, Qinghua Meng2, Wei Hou2, Dexi Chen1,†()   

  1. 1. Beijing Youan Hospital, Capital Medical University, Beijing 100069, China; Beijing Institute of Hepatology, Beijing 100069, China
    2. Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
  • Received:2017-10-24 Published:2018-06-15
  • Corresponding author: Dexi Chen
  • About author:
    Corresponding author: Chen Dexi, Email:
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谢放, 孟庆华, 侯维, 陈德喜. HBeAg阳性慢性乙型肝炎合并非酒精性脂肪肝患者的临床与病理学特征[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(03): 256-261.

Fang Xie, Qinghua Meng, Wei Hou, Dexi Chen. Clinical and pathological on HBeAg-positive patients with chronic hepatitis B complicated with nonalcoholic fatty liver disease[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(03): 256-261.

目的

探讨HBeAg阳性慢性乙型肝炎患者合并非酒精性脂肪肝病（NAFLD）的临床与病理学特征。

方法

选取2013年6月至2017年12月首都医科大学附属北京佑安医院病理确诊的慢性HBV感染（CHI）患者（108例）、NAFLD患者（120例）及HBeAg阳性慢性乙型肝炎合并NAFLD患者（132例）共360例。入组病例均行肝组织活检术，标本分别行HBsAg和HBcAg检测和HE染色。光学显微镜下观察肝组织脂肪变性和纤维化程度。比较各组患者血清学指标以及病理学特征。

结果

较CHI患者，NAFLD患者和HBeAg（+）CHB合并NAFLD患者ALT水平显著升高，差异具有统计学意义（P均< 0.05）。较CHI和NAFLD患者，HBeAg（+）CHB合并NAFLD患者的AST与尿酸水平均显著升高，差异具有统计学意义（P均< 0.05）。较NAFLD患者，HBeAg（+）CHB合并NAFLD患者的甘油三酯（TG）水平显著降低，肝纤维化程度显著升高。CHI患者、NAFLD患者和HBeAg（+）CHB合并NAFLD患者三组患者的肌酐水平逐渐升高，差异具有统计学意义（P < 0.05）。各组患者两两比较高尿酸血症所占比例差异均有统计学意义（P均< 0.05）。与CHI患者和NAFLD患者相比，HBeAg（+）CHB合并NAFLD患者中男性高尿酸血症患者比例显著升高，差异具有统计学意义（P均< 0.05）。

结论

炎症和纤维化发生率在HBeAg（+）CHB合并NAFLD患者中升高，提示NAFLD的存在可能与CHB病情进展有协同作用。

关键词: 肝炎，病毒，乙型, e抗原, 脂肪肝, 肝组织活检
Objective

To investigate the clinical and pathological features of HBeAg-positive patients with chronic hepatitis B (CHB) complicated with nonalcoholic fatty liver disease (NAFLD).

Methods

Total of 360 patients were collected from February 2013 to December 2017 in Beijing Youan Hospital, Capital Medical University, including 108 patients with chronic HBV infection, 120 patients with NAFLD and 132 patients with NAFLD and HBeAg-positive chronic hepatitis B. Liver biopsy was performed for all the patients, and the samples were detected for HBsAg and HBcAg, stained with HE. Lipid degeneration and fibrosis of liver tissue were observed under optical microscope. The serological indicators and pathological features of each group were compared.

Results

Compared with CHI patients, the levels of ALT in patients with NAFLD and HBeAg (+) CHB and NAFLD increased significantly, with significant differences (all P < 0.05). Compared with CHI patients and the patients with NAFLD, the levels of AST and uric acid in patients with HBeAg (+) CHB and NAFLD were significantly elevated, with significant differences (all P < 0.05). Compared with patients with NAFLD, the level of triglyceride (TG) in patients with HBeAg (+) CHB and NAFLD was significantly decreased, the degree of liver fibrosis was significantly increased. Creatinine levels gradually increased in patients with CHI, patients with NAFLD and patients with HBeAg (+) CHB and NAFLD, with significant difference (P < 0.05). There was significant differences in the proportion of hyperuricemia between patients of every two groups (P < 0.05). Compared with CHI patients and patients with NAFLD, the proportion of male patients with high uric acid hematic disease in HBeAg (+) CHB and NAFLD group was significantly high (P < 0.05).

Conclusions

The incidence of inflammation and fibrosis is elevated in patients with HBeAg (+) CHB and NAFLD, which suggested that the presence of NAFLD may have a synergistic effect with the progression of CHB.

Key words: Hepatitis B, E antigen, Fatty liver, Liver biopsy
表1 各组患者肝功能指标、血脂及空腹血糖水平（ ± s）
组别 例数 ALT（U/L） AST（U/L） TBil（μmol/L） TG（mmol/L） FPG（mmol/L）
CHI组 108 30.80 ± 15.31 27.78 ± 9.42 1.27 ± 0.27 1.28 ± 0.46 5.20 ± 1.15
NAFLD组 120 47.17 ± 22.82 29.55 ± 13.97 1.25 ± 0.43 2.51 ± 1.27 5.18 ± 0.95
HBeAg（+）CHB合并NAFLD组 132 52.67 ± 25.25 38.27 ± 18.36 1.23 ± 0.28 1.99 ± 0.84 5.47 ± 0.85
t1值 3.646 1.063 0.090 2.219 0.450
t2值 2.500 2.400 0.056 2.272 1.716
t3值 5.870 2.820 0.303 2.177 1.247
P1值 0.001 0.295 0.923 0.077 0.659
P2值 0.016 0.023 0.956 0.064 0.094
P3值 0.000 0.007 0.765 0.042 0.230
表2 各组患者的肾功能指标（ ± s）
组别 例数 sUA（mmol/L） UREAa（μmol/L） Cr（μmol/L）
CHI组 108 316.19 ± 105.14 1.03 ± 0.12 63.16 ± 11.12
NAFLD组 120 337.2 ± 95.1 1.25 ± 0.43 54.95 ± 16.68
HBeAg（+）CHB合并NAFLD组 132 377.6 ± 87.62 1.23 ± 0.28 79.0 ± 38.41
t1值 0.309 1.17 2.57
t2值 2.28 1.833 4.18
t3值 2.9 1.0 1.65
P1值 0.758 0.261 0.020
P2值 0.027 0.072 < 0.001
P3值 0.006 0.334 0.118
表3 各组患者尿酸水平及性别特征[例（%）]
组别 例数 男性 高尿酸血症 男性高尿酸血症占男性总例数比例
CHI组 108 72 18（16.7） 6（8.3）
NAFLD组 120 54 30（25.0） 18（33.3）
HBeAg（+）CHB合并NAFLD组 132 90 54（40.9） 48（53.0）
χ21值 2.37 12.50
χ22值 5.83 5.43
χ23值 14.76 36.45
P1值 0.123 < 0.001
P2值 0.016 0.019
P3值 < 0.001 < 0.001
表4 各组患者肝脏炎症和肝脏纤维化分级[例（%）]
组别 例数 ≥ G2 ≥ S2
CHI组 108 24（22.22） 24（22.22）
NAFLD组 120 18（15.00） 6（5.00）
HBeAg（+）CHB合并NAFLD组 132 24（18.18） 30（12.80）
χ21值 1.97 0.77
χ22值 0.45 16.13
χ23值 0.61 0.01
P1值 0.160 0.380
P2值 0.502 < 0.001
P3值 0.435 0.928
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