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慢性HBV感染者肝纤维化特征及显著性肝损伤危险因素分析

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目的 探究慢性乙型肝炎病毒(HBV)感染者肝纤维化情况及临床特征和显著性肝损伤的危险因素。方法 纳入2018年8月-2021年1月在甘肃省武威肿瘤医院肝胆中心就诊的慢性HBV感染者,观察肝纤维化特征,通过Logistic回归模型探究发生显著性肝损伤的危险因素。结果 研究纳入3 753例慢性HBV感染者中,按照LSM水平分为F0~F4五期,年龄、性别、吸烟、抗病毒治疗、HBV家族史、肝癌(HCC)家族史、甲胎蛋白(AFP)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、白蛋白(ALB)、γ-谷氨酰转肽酶(GGT)、控制衰减指数(CAP)、肝脏硬度值(LSM)在肝纤维化各期差异均有统计学意义(P<0。05);在未经治疗患者中,年龄≥45岁、乙型肝炎e抗原(HBeAg)、AFP、ALT、DBIL、GGT是显著性肝损伤的危险因素(P<0。05);经抗病毒治疗后患者中,年龄≥45岁、AFP、AST、TBIL、DBIL、GGT及呕血黑便症状是显著性肝损伤的危险因素,而CAP是显著性肝损伤的保护因素(P<0。05)。结论 年龄、HBeAg、AFP、ALT、AST、TBIL、DBIL、GGT、CAP水平及呕血黑便症状是显著性肝损伤的危险因素,明确危险因素对肝纤维化早期监测并及时干预,对提高患者生命质量有重要意义。
Characteristics of liver fibrosis and analysis of risk factors for significant liver injury in chronic HBV-infected patients
OBJECTIVE To investigate the liver fibrosis and clinical characteristics of chronic HBV-infected pa-tients,and to summarize the risk factors of significant liver injury.METHODS Chronic HBV-infected patients at-tending the Hepatobiliary Center of Gansu Wuwei Tumour Hospital from Aug.2018 to Jan.2021 were included to observe the characteristics of liver fibrosis,and the risk factors for the occurrence of significant liver injury were explored by logistic regression model.RESULTS Among the 3 753 chronic HBV-infected patients included in the study,they were categorized into five stages,F0-F4,according to the level of LSM,and differences in age,gen-der,smoking,antiviral treatment,HBV-family history,HCC-family history,AFP,ALT,AST,TBIL,DBIL,IBIL,ALB,GGT,CAP,and LSM were statistically significant at all stages of liver fibrosis.In untreated pa-tients,age≥45 years,HBeAg,AFP,ALT,DBIL,and GGT were risk factors for significant liver injury.A-mong patients after antiviral treatment,age≥45 years,AFP,AST,TBIL,DBIL,GGT,and symptom of vomi-ting blood and black stool were risk factors for significant liver injury,while the CAP was a protective factor for significant liver injury.CONCLUSION Age,HBeAg,AFP,ALT,AST,TBIL,DBIL,GGT,CAP levels,and symptoms of vomiting blood and black stool were the influencing factors of significant liver injury,and the clarifi-cation of the influencing factors was of great significance for the early monitoring of liver fibrosis and timely inter-vention to improve the quality of life of patients.

Chronic hepatitis BLiver fibrosisSignificant liver injuryLiver stiffness measurementRisk factor

李怡君、袁筱婕、张文华、王凤梅、邵中军、吉兆华、张维璐

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包头医学院公共卫生学院,内蒙古包头 014040

空军军医大学军事预防医学系军队防疫与流行病学教研室,特殊作业环境危害评估与防治教育部重点实验室,陕西西安 710032

甘肃省武威肿瘤医院肝胆中心,甘肃武威 730000

慢性乙型肝炎 肝纤维化 显著性肝损伤 肝脏硬度值 危险因素

陕西省自然科学基金

2023-JC-QN-0987

2024

中华医院感染学杂志
中华预防医学会 中国人民解放军总医院

中华医院感染学杂志

CSTPCD北大核心
影响因子:1.885
ISSN:1005-4529
年,卷(期):2024.34(12)