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[目的]研究伴有肥胖的慢性乙型肝炎(CHB)患者长期肝功能异常的原因,为临床治疗提供理论依据。[方法]观察CHB并非酒精性脂肪性肝炎(NASH)(合并)组81例,CHB无NASH(CHB)组78例,NASH无CHB病史(NASH)组65例患者内脏性肥胖、体重指数、腰臀比例、空腹血糖、血脂、血压、血清病毒学及其标志物、血清丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)等指标。[结果]合并组ALT与CHB组相似(P>0.05),比NASH组要高(P<0.05)。但合并组的HBeAg阳性率、HBV DNA阳性、病毒载量明显低于CHB组,差异无统计学意义(P>0.05)。[结论]当CHB患者年龄在40~50岁,ALT升高≤250 U/L,病毒复制程度不高,有中心性肥胖,血脂、血糖增高者应考虑CHB并NASH,需两者同时积极治疗,以减少肝硬化、心血管疾病的发生率,改善预后。
[Objective] To investigate the causes of long-term liver dysfunction in obese patients with chronic hepatitis B (CHB) and provide a theoretical basis for clinical treatment. [Method] The clinical data of 81 CHB patients without alcoholic steatohepatitis (NASH) (combination group), 78 CHB patients without NASH (CHB) and 65 patients with NASH without NASB were observed. [Methods] Hip ratio, fasting blood glucose, blood lipids, blood pressure, serum virology and its markers, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and other indicators. [Results] ALT was similar to CHB group (P> 0.05), higher than NASH group (P <0.05). However, the positive rates of HBeAg and HBV DNA in the combined group were significantly lower than those in the CHB group, with no significant difference (P> 0.05). [Conclusion] CHB and NASH should be considered when patients with CHB are aged 40 to 50 years with elevated ALT ≤250 U / L and viral replication is not high, with central obesity, elevated blood lipids and blood glucose. , To reduce the incidence of cirrhosis and cardiovascular disease and improve the prognosis.