【作者】 张鹏飞；

【导师】 左维泽；

【作者基本信息】 石河子大学 ， 内科学（专业学位）， 2020， 硕士

【摘要】 目的:通过对比分析CHB+MS患者与CHB患者的临床特征,了解MS对CHB病情的影响。方法:使用横断面调查的方法收集2017年1月-2019年8月期间在石河子大学医学院第一附属医院就诊的未接受过抗乙肝病毒治疗的327例CHB患者。按照是否合并代谢综合症分为CHB+MS组和CHB组。其中CHB+MS组为病例组,共130例,男性89例,女性41例,平均年龄(47.22±10.53)岁;CHB组为对照组,共197例,其中男性138例,女性59例,平均年龄(46.20±11.75)岁。在治疗前采集空腹肘静脉血,使用医院相关仪器完成血液常规、血液生化、乙肝两对半、HBV DNA检测;由医院影像科的专职检验技师、影像诊断医师完成肝胆脾彩超、肝脏CT及肝脏弹性硬度扫描。对比分析两组患者就诊时年龄、性别构成、BMI、肝损伤分级构成以及血液生化、血清HBV DNA载量、LSM值、CAP值、APRI模型、FIB-4指数等临床指标。结果:两组患者在年龄、性别构成、肝损伤分级构成方面的差异无统计学意义,(p>0.05),具有可比性。(1)CHB+MS组患者的BMI、高血压患病率、空腹血糖、TG、TC、LDL、尿酸均明显高于CHB组患者,同时血清HDL-C较后者明显降低,差异有显著意义(P<0.05)。(2)两组患者血清ALT、AST、白蛋白、球蛋白、TBil等指标无差异(p>0.05),而血清GGT水平较后者明显升高,差异有有显著意义(P<0.05)。(3)CHB+MS组患者血清HBV DNA载量低于CHB组,差异有显著意义(p<0.05)。(4)CHB+MS组患者LSM、APRI的均值均高于CHB组,但差异无显著意义(p>0.05);CHB+MS组患者CAP、FIB-4均值明显高于CHB组患者,差异有显著意义(P<0.05)。结论:合并代谢综合征的慢性乙型肝炎患者反应肝脏炎症的酶学指标无明显升高。合并代谢综合征的慢性乙型肝炎患者HBV复制可能受到抑制。合并代谢综合征的患者中进展性肝纤维化更多,中重度的脂肪肝发病率更高,提示代谢综合征可能是加速慢性乙型肝炎患者肝纤维化进展的重要原因。更多还原

【Abstract】 Objective:To compare and analyze the clinical characteristics of CHB+MS patients and CHB patients,and to understand the effect of MS on the condition of CHB.Methods : A cross-sectional survey was used to collect 327 CHB patients who had not received anti-hepatitis B virus therapy in the first affiliated Hospital of Medical College of Shihezi University from January 2017 to August 2019.According to whether they were complicated with metabolic syndrome or not,they were divided into CHB+MS group and CHB group.There were 130 cases in CHB + MS group,89 males and 41 females,with an average age of(47.22 ± 10.53)years.There were 197 cases in CHB group,138 males and 59 females,with an average age of(46.20 ± 11.75)years.Before the treatment,the fasting elbow vein blood was collected,and the blood routine,blood biochemistry,hepatitis B two and a half,HBV DNA detection(the lower limit of HBV detection is 100 copies / ml)were completed with the hospital related instruments;the full-time inspection technician and imaging diagnosis physician in the imaging department of the hospital completed the liver,gallbladder and spleen color ultrasound,liver CT and liver elastic hardness scanning.The age,sex composition,BMI,liver injury grade composition,blood biochemistry,serum HBV DNA load,CAP,LSM,APRI model,FIB-4 index and other clinical indexes were compared and analyzed.Results:There was no significant difference in age,sex and liver injury grade between the two groups(p>0.05).(1)BMI,prevalence of hypertension,fasting blood glucose,TG,TC,LDL and uric acid in CHB +MS group were significantly higher than those in CHB group,while serum HDL-C was significantly lower than that in CHB + MS group(P < 0.05).(2)There was no difference in serum ALT,AST,albumin,globulin and TBIL between the two groups(P > 0.05),but the serum γ GGT level was significantly higher than the latter(P < 0.05).(3)The HBV DNA load in CHB + MS group was lower than that in CHB group(P < 0.05).(4)The mean value of LSM and Apri in CHB + MS group was higher than that in CHB group,but the difference was not statistically significant(P > 0.05);the mean value of cap and FIB-4 in CHB +MS group was significantly higher than that in CHB group,and the difference was statistically significant(P < 0.05).Conclusion:In chronic hepatitis B patients with metabolic syndrome,there was no significant increase in the enzyme index of reaction to liver inflammation,but the enzyme index of reaction metabolism increased.HBV replication may be inhibited in patients with metabolic syndrome.The incidence rate of progressive liver fibrosis in group CHB+MS was higher,and the incidence of moderate to severe fatty liver was higher.This suggests that metabolic syndrome may be an important reason for accelerating the progression of liver fibrosis in patients with chronic hepatitis B.更多还原