摘要
目的了解北京市某医院慢性乙型肝炎(chronic hepatitis B,CHB)患者中合并非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)的患病率、趋势,并分析可能影响因素,探讨两种疾病间的相互关系,为CHB合并NAFLD患者的诊治提供新的策略。方法收集2013—2022年北京市某医院消化科及肝病科确诊的单纯CHB患者、CHB合并NAFLD患者以及单纯NAFLD患者的临床资料,根据其首次就诊时间分为2013—2015年、2016—2019年以及2020—2022年3个时间段,对不同时间段单纯CHB组、CHB合并NAFLD组以及单纯NAFLD组患者的一般资料、生物化学指标及病毒学检测指标进行分析,采用多因素logistic回归分析CHB患者发生NAFLD的影响因素。结果本研究共纳入单纯CHB患者9081例,CHB合并NAFLD患者1760例,单纯NAFLD患者8462例。CHB患者中NAFLD的患病率从2013—2015年的12.93%(489/3781)上升至2016—2019年的15.60%(691/4429),2020—2022年达22.04%(580/2631);与CHB组、NAFLD组比较,CHB合并NAFLD组在2013—2015年、2016—2019年和2020—2022年3个时间段糖尿病比例(5.32%比1.85%比23.17%;5.21%比1.71%比20.14%;3.45%比2.05%比29.09%)、高脂血症比例(4.91%比1.22%比35.03%;4.78%比1.50%比31.57%;3.80%比1.71%比29.09%)、空腹血糖(5.20比5.01比5.36 mmol/L;5.26比5.02比5.41 mmol/L;5.23比5.06比5.38 mmol/L)、胆固醇(4.71比4.40比5.07 mmol/L;4.91比4.47比4.99 mmol/L;4.90比4.64比5.07 mmol/L)、甘油三酯(1.40比0.97比1.66 mmol/L;1.45比0.99比1.66 mmol/L;1.48比0.97比1.68 mmol/L)高于CHB组,低于NAFLD组,差异有统计学意义(均P<0.05);多因素logistic回归分析显示,高龄(OR=1.01,95%CI:1.00~1.01)、男性(OR=1.65,95%CI:1.41~1.94)、丙氨酸转氨酶(OR=1.41,95%CI:1.21~1.64)、空腹血糖(OR=1.79,95%CI:1.46~2.21)、低密度脂蛋白(OR=1.75,95%CI:1.36~2.25)、甘油三酯(OR=2.57,95%CI:2.17~3.03)、尿酸(OR=1.96,95%CI:1.65~2.32)水平升高,高密度脂蛋白(OR=1.52,95%CI:1.30~1.78)水平降低是CHB发生NAFLD的独立影响因素。结论2013—2022年CHB患者中NAFLD的患病率升幅较大,CHB合并NAFLD患者易发生代谢功能障碍。
Objective To explore the epidemiological characteristics of chronic hepatitis B(CHB)comorbid with nonalcoholic fatty liver disease(NAFLD)in a hospital in Beijing,analyze potential influencing factors,and explore the interrelationship between these two conditions,ultimately providing new strategies for the diagnosis and treatment of CHB patients with NAFLD.Methods Clinical data were collected from patients diagnosed with pure CHB,CHB combined with NAFLD,and pure NAFLD in the Digestive and Hepatology Departments of a Beijing hospital from 2013 to 2022.Patients were categorized into three time periods based on their first visit:2013-2015,2016-2019,and 2020-2022.General information,biochemical indicators,and virological test results for patients in each group were analyzed across the different time periods.Multivariate logistic regression analysis was performed to identify factors influencing the occurrence of NAFLD in CHB patients.Results A total of 9081 pure CHB patients,1760 CHB patients with NAFLD,and 8462 pure NAFLD patients were included in this study.The prevalence of NAFLD among CHB patients increased from 12.93%(489/3781)in 2013-2015 to 15.60%(691/4429)in 2016-2019,reaching 22.04%(580/2631)from 2020 to 2022.Compared to the pure CHB and NAFLD groups,the CHB with NAFLD group exhibited significantly higher rates of diabetes(5.32%vs 1.85%vs 23.17%;5.21%vs 1.71%vs 20.14%;3.45%vs 2.05%vs 29.09%),hyperlipidemia(4.91%vs 1.22%vs 35.03%;4.78%vs 1.50%vs 31.57%;3.80%vs 1.71%vs 29.09%),fasting blood glucose(5.20 vs 5.01/L vs 5.36 mmol/L;5.26 vs 5.02 vs 5.41 mmol/L;5.23 vs 5.06 vs 5.38 mmol/L),cholesterol(4.71 vs 4.40 vs 5.07 mmol/L;4.91 vs 4.47 vs 4.99 mmol/L;4.90 vs 4.64 vs 5.07 mmol/L),and triglycerides(1.40 vs 0.97 vs 1.66 mmol/L;1.45 vs 0.99/L vs 1.66 mmol/L;1.48 vs 0.97 vs 1.68 mmol/L)across all time periods,with statistically significant differences(all P<0.05).Multivariate logistic regression analysis showed that older age(OR=1.01,95%CI:1.00–1.01),male(OR=1.65,95%CI:1.41–1.94),elevated alanine aminotransferase(OR=1.41,95%CI:1.21–1.64),fasting blood glucose(OR=1.79,95%CI:1.46–2.21),low-density lipoprotein(OR=1.75,95%CI:1.36–2.25),triglycerides(OR=2.57,95%CI:2.17–3.03),and uric acid(OR=1.96,95%CI:1.65–2.32)and decresed high-density lipoprotein(OR=1.52,95%CI:1.30–1.78)were independent influencing factors for the development of NAFLD in CHB patients.Conclusions The prevalence of NAFLD among CHB patients significantly increased from 2013 to 2022,highlighting a tendency for metabolic dysfunction in patients with CHB combined with NAFLD.
作者
殷珂
宋玉芸
黄子翔
武楠
费然
丛旭
饶慧瑛
刘峰
王子兴
YIN Ke;SONG Yuyun;HUANG Zixiang;WU Nan;FEI Ran;CONG Xu;RAO Huiying;LIU Feng;WANG Zixing(Peking University People's Hospital,Peking University Hepatology Institute,Infectious Disease and Hepatology Center of Peking University People's Hospital,Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases,Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis,Beijing 100044,China;不详)
出处
《中国病毒病杂志》
2025年第4期363-369,共7页
Chinese Journal of Viral Diseases
基金
国家自然科学基金(82170584,82304215)
北京自然科学基金(7242151)
其敏计划。
关键词
慢性乙型肝炎
非酒精性脂肪性肝病
患病率
临床特征
Chronic hepatitis B
Nonalcoholic fatty liver disease
Prevalence
Clinical characteristics
