慢性乙型肝炎合并肝脂肪变的临床特征及病理改变

发布时间：2018-03-18 07:17

本文选题：乙型　切入点：慢性　出处：《宁波大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨慢性乙型肝炎(CHB)合并肝脂肪变患者的临床特征和病理学特点,探索两病合并时是否存在相互协同、促进疾病进展情况;希望通过研究发现或筛选一些临床特征性指标,为临床对CHB合并肝脂肪变患者能更好的早期发现、病情评估等提供参考。方法:回顾性分析2004年2月至2013年4月在宁波市第二医院就诊并接受肝穿刺活检术的慢性HBV感染者1036例,根据其肝组织病理,按肝组织是否发生脂肪变,将患者分为CHB组(对照组,847例)和CHB合并脂肪肝组(观察组,189例)。其中CHB合并脂肪肝组按脂肪变性肝细胞占所有肝细胞比例在分为轻度组(156例)和中重度组(33例)。统计有关的一般资料、生化学指标、病毒学指标及肝组织学结果,并对数据进行分析。计量资料中正态分布组间比较采用t检验,非正态分布组间比较采用两独立样本非参数秩和检验(Mann—Whitney U),计数资料组间比较采用卡方(χ2)检验,两变量间相关性分析采用Spearman相关分析。结果:CHB患者肝脂肪变发病率男性明显高于女性(χ=28.298,P0.001),差异有统计学意义。在30岁和30~44岁年龄段中,男性发病率明显高于女性,差异有统计学意义(χ2分别为15.46和14.571,P0.001),而在45岁年龄段中,男性与女性差异无统计学意义(χ2=0.227,P0.05)。观察组的碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、尿酸、血糖、总胆固醇、甘油三脂水平高于对照组,差异有统计学意义(P0.05),而白蛋白、球蛋白、谷丙转氨酶(ALT)、门冬氨酸转移酶(AST)、HBV-DNA水平差异无统计学意义(P0.05),两组间肝组织炎症程度比较,差异无统计学意义(P0.05),两组间肝组织纤维化程度(S)比较总体差异不明显,但观察组中S3级的比例大,差异有统计学意义(P0.05)。不同程度肝脂肪变组间对比,中重度肝脂肪变组ALT、AST、ALP、GGT水平均较高,两组差异有统计学意义(P0.05),而白蛋白、球蛋白、尿酸、血糖、总胆固醇、甘油三酯及HBV-DNA差异无统计学意义(P0.05),两组间肝组织炎症程度差异无统计学意义(P0.05),纤维化程度差异有统计学意义(P0.05)。结论:CHB合并肝脂肪变与性别、年龄、ALP、GGT、尿酸、血糖、总胆固醇、甘油三脂水平相关,ALP、GGT还与肝脂肪变的严重程度有关。HBV与肝脂肪变无直接相关,ALT、AST水平升高可能是脂肪肝所致,抗病毒治疗需慎重。肝脂肪变对肝组织炎症程度无明显影响,而肝脂肪变是否易发生在纤维化程度低的CHB患者有待于进一步研究论证。
[Abstract]:Objective: to investigate the clinical and pathological features of patients with chronic hepatitis B (CHB) complicated with hepatic steatosis, and to explore whether there is synergy between the two diseases in order to promote the progress of the disease. It is hoped that some clinical characteristic indexes can be found or screened in order to make a better early diagnosis for CHB patients with hepatic adiposis. Methods: from February 2004 to April 2013, 1 036 patients with chronic HBV infection who were treated in Ningbo second Hospital and received liver biopsy were analyzed retrospectively. According to the pathological changes of liver tissue, there was fatty change in liver tissue. The patients were divided into CHB group (control group, n = 847) and CHB with fatty liver group (observation group, n = 189). The group of CHB with fatty liver was divided into mild group (n = 156) and moderate and severe group (n = 33) according to the proportion of fatty liver cells to all hepatocytes. Statistical and relevant general information, Biochemistry index, virology index and liver histological results were analyzed. T test was used to compare the normal distribution groups in the metrological data. The nonparametric rank sum test (Mann-Whitney Uney test) of two independent samples was used to compare non-normal distribution groups, and chi-square test (蠂 2) was used to compare counting data groups. Results the incidence of hepatic fatty change in male was significantly higher than that in female (蠂 ~ (2 +) 28.298) P 0.001 (蠂 ~ (2 +)). The incidence of liver fat in male was significantly higher than that in female at 30 and 30 ~ 44 years of age (蠂 ~ (28) 298) (P < 0. 001). The difference was statistically significant (蠂 ~ 2 = 15.46 and 14.571g P 0.001, respectively), but there was no significant difference between male and female in the age of 45 years (蠂 ~ 2 / 0.227) P 0.05. The alkaline phosphatase (ALP), glutamyl transpeptidase (GGTN), uric acid, blood glucose, total cholesterol in the observation group were significantly higher than those in the control group. The level of triglyceride was significantly higher than that of the control group (P 0.05), while the levels of albumin, globulin, alanine aminotransferase (alt), aspartate transferase (AST) and HBV-DNA were not significantly different between the two groups. There was no significant difference between the two groups (P 0.05). There was no significant difference in the degree of hepatic fibrosis between the two groups, but the proportion of grade S3 in the observation group was large, and the difference was statistically significant (P 0.05). The levels of GGT of ALP in moderate and severe liver fatty degeneration group were higher than those in control group. The difference between the two groups was statistically significant (P 0.05), while albumin, globulin, uric acid, blood sugar, total cholesterol, albumin, globulin, uric acid, blood glucose, total cholesterol, There was no significant difference in triglyceride and HBV-DNA between the two groups (P 0.05). There was no significant difference in inflammatory degree of liver tissue between the two groups (P 0.05), but there was a significant difference in the degree of fibrosis (P 0.05). Conclusion there is a significant difference in the degree of hepatic fibrosis between the two groups. Conclusion: there is no significant difference between the two groups in liver fat change and sex, age, age, ALP GGTs, uric acid, blood sugar, total cholesterol, and so on. There is no direct correlation between HBV and liver fat change. The elevation of alt AST level may be caused by fatty liver, and antiviral therapy should be careful. Hepatic fatty degeneration has no obvious effect on the degree of liver inflammation. Whether hepatic fatty degeneration is easy to occur in CHB patients with low degree of fibrosis needs further study.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R575

【相似文献】