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目的探讨慢性乙型肝炎合并非酒精性脂肪性肝病(NAFLD)患者的临床和病理特征。方法对75例慢性乙型肝炎合并NAFLD患者进行肝穿刺组织活检和肝脏CT平扫,同时检测血液生化学指标,并与75例慢性乙型肝炎和41例NAFLD比较。结果慢性乙型肝炎合并NAFLD患者血清ALT、AST和GGT水平较慢性乙型肝炎和NAFLD患者明显增高(P<0.05,P<0.01);血清TC、TG、FBS、INS和IR I水平较单纯慢性乙型肝炎患者明显升高(P<0.05,P<0.01),而与NAFLD比较差异无统计学意义(P>0.05);脂肪变程度与慢性乙型肝炎组及NAFLD患者比较差异无统计学意义(P>0.05),而炎症计分和纤维化计分则明显升高,差异有统计学意义(P<0.05);肝/脾CT比值较慢性乙型肝炎降低(P<0.05),而较NAFLD患者高(P<0.05)。结论慢性乙型肝炎合并NAFLD患者的临床和病理特征不同于单纯的慢性乙型肝炎和非酒精性脂肪性肝病,NAFLD对慢性乙型肝炎进展有协同作用。
Objective To investigate the clinical and pathological features of patients with chronic hepatitis B complicated with non-alcoholic fatty liver disease (NAFLD). Methods Seventy-five patients with chronic hepatitis B and NAFLD underwent liver biopsy and CT scan of the liver. Blood biochemical parameters were measured and compared with 75 patients with chronic hepatitis B and 41 patients with NAFLD. Results Serum levels of ALT, AST and GGT in patients with chronic hepatitis B and NAFLD were significantly higher than those in patients with chronic hepatitis B and NAFLD (P <0.05, P <0.01). Serum levels of TC, TG, FBS, (P <0.05, P <0.01), but no significant difference compared with NAFLD (P> 0.05). There was no significant difference in the degree of steatosis between patients with chronic hepatitis B and NAFLD (P> 0.05), but the scores of inflammation and fibrosis were significantly higher (P <0.05), and the ratios of liver / spleen CT were lower than those of chronic hepatitis B (P <0.05) NAFLD patients (P <0.05). Conclusion The clinical and pathological features of patients with chronic hepatitis B and NAFLD are different from those of simple chronic hepatitis B and nonalcoholic fatty liver disease. NAFLD has a synergistic effect on the progression of chronic hepatitis B.