慢性丙型肝炎合并代谢相关脂肪性肝病患者的临床特征及预后评价

摘要/Abstract

摘要： 目的评价慢性丙型肝炎(CHC)合并代谢相关脂肪性肝病(MAFLD)患者的临床特征及预后情况。方法选取2014年1月—2022年2月平顶山市第二人民医院收治CHC患者进行回顾性研究,共354例,年龄44(35,53)岁,其中男173例、女181例。根据CHC患者是否合并MAFLD分为单纯CHC组、MAFLD组,并进行单因素和多因素分析,以确定与CHC合并MAFLD肝纤维化程度相关独立预测因素。结果单纯CHC组、MAFLD组分别为225例、129例,MAFLD发生率为36.4%。比较两组临床资料,单纯CHC组男性为122例(54.2%),明显高于MAFLD组[51例(39.5%),P<0.05];单纯CHC组BMI、ALT、AST、TC、TG、HbA1c及HOMA-IR分别为25(22,29)kg/m²、78(44,151)U/L、54(37,152)U/L、4.3(3.7,5.0)mmol/L、0.9(0.7,1.3)mmol/L、5.0(4.8,5.7)%及1.7(1.1,3.1),均显著低于MAFLD组[27.5(23,32)kg/m²、91(54,168)U/L、70(44,114)U/L、4.5(3.8,5.4)mmol/L、1.1(0.8,1.7)mmol/L、5.5(5.0,6.3)%及3.4(1.8,5.5),P<0.05];与单纯CHC组[1.3(1.1,1.8)mmol/L]相比,MAFLD组HDL明显降低[(1.1(0.9,1.5)mmol/L,P<0.05];单纯CHC组糖尿病、进展期肝纤维化比率为3例(1.3%)、30例(13.3%),均显著低于MAFLD组[11例(8.5%)、43例(33.3%),P<0.05]。logistic单因素回归分析显示,年龄、性别、BMI、糖尿病及MAFLD可能影响CHC肝纤维化程度(P值均<0.05)。采用Forward LR法将年龄、性别、BMI、糖尿病及MAFLD纳入logistic多因素回归分析,结果显示年龄、MAFLD是CHC患者进展期肝纤维化发生的独立危险因素[OR分别=1.05(95%CI:1.03～1.07)、2.45(95%CI:1.64～3.77),P<0.001],而男性则为保护性因素[OR=0.52(95%CI:0.26～0.78),P=0.007]。结论合并MAFLD的CHC患者存在更为严重的肝纤维化状态,年龄、MAFLD是CHC患者进展期肝纤维化发生的独立危险因素,而男性则为保护性因素。

关键词: 慢性丙型肝炎, 代谢相关脂肪性肝病, 肝纤维化

Abstract: Objective To investigate of the clinical characteristics and prognosis of patients with chronic hepatitis C (CHC) complicated with metabolic associated fatty liver disease (MAFLD).Methods A total of 354 patients (173 males and 181 females) with CHC from January 2014 to February 2022 in our hospital were selected, with an age of 44 (35, 53) years. Patients with CHC were divided into simple CHC group and MAFLD group according to whether they were combined with MAFLD. Univariate and multivariate analyses were performed to identify independent predictors associated with the degree of liver fibrosis in CHC combined with MAFLD.Results There were 225 cases in CHC group and 129 cases in MAFLD group respectively, and the incidence of MAFLD was 36.4%. Comparing the clinical data of the 2 groups, the number of men in the simple CHC group was 122 (54.2%), which was significantly higher than that in the MAFLD group [51 cases (39.5%), P<0.05]; The body mass index (BMI), aspartate aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), HbA1c and HOMA-IR ofn simple CHC group were significantly lower than those of MAFLD group [25 (22, 29) kg/m², 78 (44, 151) U/L, 54 (37, 152) U/L, 4.3 (3.7, 5.0) mmol, 0.9 (0.7, 1.3) mmol/L, 5.0 (4.8, 5.7) % and 1.7 (1.1, 3.1)] vs [27.5 (23, 32) kg/m², 91 (54, 168) U/L, 70 (44, 114) U/L, 4.5 (3.8, 5.4) mmol/L, 1.1 (0.8, 1.7) mmol/L, 5.5 (5.0, 6.3) % and 3.4 (1.8, 5.5), P<0.05]. Compared with simple CHC group [1.3 (1.1, 1.8) mmol/L], high density lipoprotein (HDL) in MAFLD group was significantly lower [1.1 (0.9, 1.5) mmol/L, P<0.05]. The rates of diabetes mellitus and progressive liver fibrosis in simple CHC group were 3 cases (1.3%) and 30 cases (13.3%), which were significantly lower than those in MAFLD group [11 cases (8.5%) and 43 cases (33.3%), P<0.05]. The logistic univariate regression analysis showed that age, gender, BMI, diabetes mellitus and MAFLD may influence the degree of hepatic fibrosis in CHC (all P values<0.05). The Forward LR method was used to include age, gender, BMI, diabetes mellitus and MAFLD in logistic multi-factor regression analysis, and the results showed that age and MAFLD were independent risk factors for the development of progressive liver fibrosis in CHC patients [OR=1.05 (95% CI: 1.03~1.07), 2.45 (95% CI: 1.64~3.77), respectively, P<0.001], men were the protective factors [OR=0.52 (95% CI: 0.26 ~ 0.78), P=0.007].Conclusion CHC patients with combined MAFLD have a more severe state of liver fibrosis, and age and MAFLD are independent risk factors for the development of progressive liver fibrosis in CHC patients, while men is a protective factors.

Key words: Chronic hepatitis C, Metabolic associated fatty liver disease, Hepatic fibrosis

冯薇薇, 孔严, 康茹. 慢性丙型肝炎合并代谢相关脂肪性肝病患者的临床特征及预后评价[J]. 肝脏, 2023, 28(5): 534-536.

FENG Wei-wei, KONG Yan, KANG Ru. Evaluation of clinical characteristics and prognosis in patients with chronic hepatitis C complicated with metabolic-related fatty liver disease[J]. Chinese Hepatolgy, 2023, 28(5): 534-536.

参考文献

[1] Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol, 2020, 73(1):202-209.
[2] Yuan Q, Wang H, Gao P, et al. Prevalence and Risk Factors of Metabolic-Associated Fatty Liver Disease among 73,566 Individuals in Beijing, China. Int J Environ Res Public Health, 2022, 19(4):2096.
[3] Guan L, Zhang X, Tian H, et al. Prevalence and risk factors of metabolic-associated fatty liver disease during 2014-2018 from three cities of Liaoning Province: an epidemiological survey. BMJ Open, 2022, 12(2):e047588.
[4] Taheri E, Moslem A, Mousavi-Jarrahi A, et al. Predictors of metabolic-associated fatty liver disease (MAFLD) in adults: a population-based study in Northeastern Iran. Gastroenterol Hepatol Bed Bench, 2021, 14(Suppl1):S102-S111.
[5] Farrell AM, Magliano DJ, Shaw JE, et al. A problem of proportions: estimates of metabolic associated fatty liver disease and liver fibrosis in Australian adults in the nationwide 2012 AusDiab Study. Sci Rep, 2022, 12(1):1956.
[6] Fouad Y, Esmat G, Elwakil R, et al. The egyptian clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Saudi J Gastroenterol, 2022, 28(1):3-20.
[7] Al-Omary A, Byth K, Weltman M, et al. The importance and impact of recognizing metabolic dysfunction-associated fatty liver disease in patients with chronic hepatitis C. J Dig Dis, 2022, 23(1):33-43.
[8] van Kleef LA, Choi HSJ, Brouwer WP, et al. Metabolic dysfunction-associated fatty liver disease increases risk of adverse outcomes in patients with chronic hepatitis B. JHEP Rep, 2021, 3(5):100350.
[9] Nevola R, Acierno C, Pafundi PC, et al. Chronic hepatitis C infection induces cardiovascular disease and type 2 diabetes: mechanisms and management. Minerva Med, 2021, 112(2):188-200.
[10] Qasim SF, Jami A, Imran P, et al. Frequency of metabolic syndrome in chronic hepatitis C patients: findings from a lower middle income country. Cureus, 2020, 12(12):e11975.
[11] 中华医学会肝病学分会, 中华医学会感染病学分会. 《丙型肝炎防治指南》2015年更新版. 实用肝脏病杂志, 2016, 19(4): 521-538.
[12] Chang ML. Metabolic alterations and hepatitis C: From bench to bedside. W orld J Gastroenterol, 2016, 22(4):1461-1476.
[13] Abenavoli L, Masarone M, Peta V, et al. Insulin resistance and liver steatosis in chronic hepatitis C infection genotype 3. World J Gastroenterol, 2014, 20(41):15233-15240.
[14] Adinolfi LE, Restivo L, Zampino R, et al. Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis. Atherosclerosis, 2012, 221(2):496-502.
[15] Parameswaran M, Hasan HA, Sadeque J, et al. Factors that predict the progression of non-alcoholic fatty liver disease (NAFLD). Cureus, 2021, 13(12):e20776.