标题：慢性丙型病毒性肝炎合并肝脂肪变的相关因素研究

      作者：刘景春 1，郭春涛 2
    (淄博市第四人民医院感染科 1、检验科 2，山东 淄博 255067)

      卷次： 2015年26卷7期

      【摘要】 目的 探讨影响慢性丙型病毒性肝炎(CHC)患者合并肝脂肪变相关因素及其临床病理特征。
方法 选取本院2011年6月至2013年6月收治的148例CHC患者为研究对象，根据患者是否合并肝脂肪变将其
分为CHC无肝脂肪变组 82例和CHC合并肝脂肪变组 66例，分析两组患者临床资料、生化指标、丙型肝炎病毒
(HCV)水平与CHC合并肝脂肪变的相关性及两组患者的肝组织学特征。结果 两组患者的性别构成比、年龄、
病程等基线资料比较差异均无统计学意义(P>0.05)，而体质指数(BMI)及腰臀比(WHR)比较则差异具有统计学意
义(P<0.05)。肝脂肪变组患者空腹血糖(FBC)、糖化血糖蛋白(HAblc)、总胆固醇(TC)、甘油三脂(TG）、低密度蛋白
(LDL-C)水平显著高于无肝脂肪变组，而高密度蛋白（HDL-C)则低于无肝脂肪变组，差异均有统计学意义(P<
0.05)。两组谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)、碱性磷酸酶(ALP)以及总胆红素
(STB)比较差异均无统计学意义(P>0.05)。两组患者抗-HCV IgG阳性及HCV RNA阳性率比较差异均无统计学
意义(P>0.05)。经Logistic多因素分析显示，WHR、FBC、TC、TG是CHC患者合并肝脂肪变独立危险因素。肝
脂肪变组与无脂肪变组相比，脂肪变性程度、炎症活动度分级及纤维化分期比较差异具有统计学意义(P<
0.05)。结论 CHC患者合并肝脂肪变与BMI、WHR及糖脂代谢紊乱密切相关，而与HCV无关。临床针对上述
影响因素对症治疗可有效预防及治疗CHC肝脂肪变。

      【关键词】 慢性丙肝；肝脂肪变；代谢异常；体质指数

      【中图分类号】 R512.6+3 【文献标识码】 A 【文章编号】 1003—6350（2015）07—0967—04


Related factors of chronic hepatitis C patients with hepatic steatosis.
LIU Jing-chun 1, GUO Chun-tao 2.
Department of Infectious Disease 1, Department of Clinical Laboratory 2, the Fourth People's Hospital of Zibo, Zibo
255067, Shandong, CHINA

【Abstract】 Objective To investigate the associated factors and pathological features of chronic hepatitis C
(CHC) patients with hepatic steatosis. Methods A total of 148 patients with CHC from June 2011 to June 2013 were
divided into CHC without steatosis group (group A, n=82) and CHC complicated with hepatic steatosis group (group
B, n=66). The clinical data, biochemical parameters, the levels of HCV viral, liver steatosis CHC concurrent correla-
tions and two liver histological features of two groups were analyzed. Results The sex ratio, age, duration and other
baseline data showed no statistically significant difference between the two groups (P>0.05), while the body mass in-
dex (BMI) and waist-hip ratio (WHR) were significantly different (P<0.05). The levels of fasting blood glucose
(FBC), blood glucose glycated protein (HAblc), total cholesterol (TC), triglyceride (TG), low density protein (LDL-C)
of group B were significantly higher than those of group A, while high-density protein (HDL-C) was significantly low-
er. The differences were statistically significant (P<0.05). The two groups showed no significant difference in alanine
aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl peptidase (γ-GT), alkaline phosphatase (ALP)
and total bilirubin (STB), and also in the rates of anti-HCV IgG and HCV RNA positive (P>0.05). Logistic multivari-
ate analysis showed that WHR, FBC, TC, TG were the risk factors for of CHC patients complicated with steatosis.
Statsitically significant difference was found between the two groups in fatty degeneration, inflammatory activity
grade and fibrosis stage (P<0.05). Conclusion The hepatic steatosis of CHC patients are closely related to levels of
BMI, WHR and lipid disorders, but unrelated to HCV. Clinical response to these factors for symptomatic treatment can
be effective in preventing and treating CHC complicated with hepatic steatosis.