摘要
目的分析不同病因和不同Child-Pugh分级的肝硬化患者血脂水平和血脂异常类型。方法2013年1月~2017年12月我科住院的448例肝硬化患者,其中乙型肝炎194例,丙型肝炎20例,酒精性46例,病毒与酒精性41例,隐源性85例,自身免疫性肝炎33例,NAFLD相关10例和血吸虫病19例。回顾性分析血脂指标,包括总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A(APOA)、载脂蛋白B(APOB)。结果在448例肝硬化患者中,221例(49.3%)存在血脂异常,其中低HDL血症207例(93.7%),混合型高脂血症1例(0.5%);186例Child A级患者血TC水平为(3.8±0.9)mmol/L,显著高于183例B级【(3.4±1.3)mmol/L,P<0.01】,或79例C级【(3.1±1.3)mmol/L,P<0.01】;A级TG为(1.1±0.6)mmol/L,显著高于B级【(0.9±0.5)mmol/L,P<0.01】,或C级【(0.9±0.5)mmol/L,P<0.01】;A组HDL为(1.3±0.4)mmol/L,显著高于B级【(1.1±0.4)mmol/L,P<0.01】,或C级【(0.8±0.4)mmol/L,P<0.01】;A级LDL为(2.1±0.6)mmol/L,显著高于B级【(1.8±0.9)mmol/L,P<0.01】,或C级【(1.7±0.8)mmol/L,P<0.01】;A级APOA为(1.1±0.3)mmol/L,显著高于B级【(0.9±0.3)mmol/L,P<0.01】,或C级【(0.8±1.3)mmol/L,P<0.01】;A级APOB为(0.7±0.2)mmol/L,显著高于B级【(0.6±0.3)mmol/L,P<0.01】;随着Child-Pugh分级变差,血脂异常率显著升高,三组分别为32.3%、52.5%和82.3%(P<0.01);NAFLD和丙型肝炎肝硬化患者血脂异常率最高,均为60%,而乙型肝炎肝硬化患者血脂异常率相对较低,为43.8%。结论肝硬化患者血脂异常以低HDL血症最常见,且随着Child-Pugh分级变差而显著升高。NAFLD和丙型肝炎肝硬化患者最容易出现血脂异常,值得关注。
Objective The aim of this study was to analyze the dyslipidemia in patients with liver cirrhosis(LC).Methods A total of 448 patients with LC were admitted to our hospital between January 2013 and December 2017,and included hepatitis B in 194,hepatitis C in 20,alcohol-induced in 46,hepatitis B or C with alcohol in 41,cryptogenic in 85,autoimmune hepatitis in 33,NAFLD in 10 and schistosomiasis in 19 cases.The blood lipid were analyzed,including total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),low density lipoprotein(LDL),apolipoprotein A(APOA)and apolipoprotein B(APOB).Results Out of the 448 patients with LC,221 cases(49.3%)had dyslipidemia,and the majority of dyslipidemia was low HDL(n=207,93.7%);the mixed hyperlipidemia was the least(n=1,0.5%);the blood TC in 186 patients with Child class A was(3.8±0.9)mmol/L,significantly higher than[(3.4±1.3)mmol/L,P<0.01]in 183 patients with class B,or[(3.1±1.3)mmol/L,P<0.01]in 79 patients with class C;the blood TG in class A was(1.1±0.6)mmol/L,significantly higher than[(0.9±0.5)mmol/L,P<0.05]in class B,or[(0.9±0.5)mmol/L,P<0.01]in class C;the HDL level was(1.3±0.4)mmol/L,significantly higher than[(1.1±0.4)mmol/L,P<0.01]in class B,or[(0.8±0.4)mmol/L,P<0.01]in class C;the LDL was(2.1±0.6)mmol/L,significantly higher than[(1.8±0.9)mmol/L,P<0.01]in class B,or[(1.7±0.8)mmol/L,P<0.01]in class C;the APOA was(1.1±0.3)mmol/L,significantly higher than[(0.9±0.3)mmol/L,P<0.01]in class B,or[(0.8±1.3)mmol/L,P<0.01]in class C;the APOB was(0.7±0.2)mmol/L,significantly higher than[(0.6±0.3)mmol/L,P<0.01]in class B;the proportion of dyslipidemia increased significantly with the Child-Pugh classification deteriorated,e.g.,the percentages of dyslipidemia was 32.3%in class A,52.5%in class B,and 82.3%in class C(P<0.01);the dyslipidemia was most common in patients with NAFLD associated(60.0%)and hepatitis C-induced LC(60.0%),and relatively less common in hepatitis B-induced(43.8%).Conclusion Low HDL level is the most common type of dyslipidemia in patients with LC,and as the liver function deteriorates,it becomes common.
作者
石翠翠
刘彦君
章瑞南
李光明
范建高
Shi Cuicui;Liu Yanjun;Zhang Ruinan(Department of Gastroenterology,XinHua Hospital,JiaoTong University School of Medicine,Shanghai,200092,China)
出处
《实用肝脏病杂志》
CAS
2021年第6期859-862,共4页
Journal of Practical Hepatology
基金
国家自然科学基金资助项目(编号:81400631)。
