【摘要】 目的研究HBeAg阴性慢性乙型肝炎并非酒精性脂肪性肝病患者的临床病理特征。方法对临床与病理学确诊的HBeAg阴性慢性乙型肝炎并非酒精性脂肪性肝病患者,检测空腹血糖与胰岛素、甘油三酯、胆固醇、丙氨酸氨基转氨酶、天冬氨酸氨基转氨酶;检测乙肝病毒标志物与HBV DNA,计数体重指数与胰岛素抵抗指数,观察其病理特征。结果HBeAg阴性慢性乙型肝炎并非酒精性脂肪性肝病患者其体重指数、胰岛素抵抗指数、空腹血糖、空腹血胰岛素、甘油三酯、胆固醇均显著高于HBeAg阴性慢性乙型肝炎患者;而转氨酶水平、HBV DNA载量低于HBeAg阴性慢性乙型肝炎患者;HBeAg阴性慢性乙型肝炎并非酒精性脂肪性肝病患者病理学改变以脂肪变性为主,汇管区及界面性炎较轻,肝细胞脂肪变主要在腺泡带、呈弥漫分布。结论HBeAg阴性慢性乙型肝炎并非酒精性脂肪性肝病患者,肝细胞脂肪变的发生主要由患者的代谢因素所致,选择性对存在代谢因素的HBeAg阴性慢性乙型肝炎患者行肝活检,有助于早期明确HBeAg阴性慢性乙型肝炎并非酒精性脂肪性肝病的诊断。更多还原

【Abstract】 Objective To investigate clinical and pathological characteristic in HBeAg negative chronic hepatitis B(CHB) patients with nonalcoholic fatty liver disease(NAFLD).Methods We measured fasting blood glucose(FBG),insulin,triglyceride,cholesterol,alanine aminotransferase(ALT),aspartate aminotransferase(AST) in HBeAg negative CHB patients with NAFLD.Hepatitis B Virus marker and HBV DNA were detected.The body mass index(BMI) and insulin resistance index were counted.The pathological parameters were analyzed.Results BMI,homeostatic model assessment of insulin resistance(HOMA-IR),FBG,insulin,triglycerides,cholesterol,were significantly higher in HBeAg negative CHB patients with NAFLD than HBeAg negative CHB patients.But ALT,AST,HBV DNA levels were significantly lower in HBeAg negative CHB patients with NAFLD than in HBeAg negative CHB patients.Histologic features in HBeAg negative CHB patients with NAFLD were in zone 3 predominate over macrovesicular steatosis and mild inflammatory infiltrate in portal region.Conclusion The hepatic steatosis changes in HBeAg negative CHB patients with NAFLD are mainly caused by the metabolic factors.It is helpful for early diagnosis in HBeAg negative CHB patients with NAFLD to selectively carry out liver biopsy for the patients with HBeAg negative CHB having metabolic factors.更多还原