自身免疫性肝炎患者肝脂肪变的发生率及危险因素

金沛桦　施军平

[摘要] 目的 了解我國自身免疫性肝炎（AIH）患者中肝脂肪变的发生率及危险因素。 方法 对80例诊断为自身免疫性肝炎的患者进行回顾性分析，根据有无合并肝细胞脂肪变分为单纯AIH组和AIH合并肝脂肪变组，比较两组患者体质指数（BMI）、空腹血糖、总胆固醇、甘油三酯、肝功能、肝纤维化等指标的差异，筛选AIH合并肝脂肪变的独立危险因素。 结果 本研究共收录80例患者，其中合并肝脂肪变者23例，发生率为28.75%，与一般人群相仿。其中女22例，占95.7%，年龄50～70岁17例，占总人数的73.9%。合并肝脂肪变的患者肝脏炎症指标显著高于AIH患者（P<0.05），两组肝纤维化指标比较无统计学差异（P>0.05）。合并肝脂肪变的AIH患者其BMI、空腹血糖、甘油三酯、总胆固醇明显高于单纯AIH患者（P<0.05），进一步回归分析显示空腹血糖为AIH患者发生肝脂肪变的独立危险因素。 结论 肝脂肪变在AIH患者中的发生率与一般人群相仿，其发生主要与患者本身代谢性因素相关，与疾病本身并无明显关系。肝细胞脂肪变并不影响AIH患者的肝纤维化进展。

[关键词] 自身免疫性肝炎；肝脂肪变；发生率；危险因素

[中图分类号] R575.1 [文献标识码] A [文章编号] 1673-9701（2018）12-0008-04

The incidence and risk factors of hepatic steatosis in patients with autoimmune hepatitis

JIN Peihua1 SHI Junping2

1.Zhejiang University of Chinese Medicine， Hangzhou 310000， China； 2.The Affiliated Hospital of Hangzhou Normal University， Hangzhou 310015， China

[Abstract] Objective To investigate the incidence and risk factors of hepatic steatosis in patients with autoimmune hepatitis（AIH） in China. Methods 80 patients diagnosed with autoimmune hepatitis were retrospectively analyzed. According to the presence or absence of hepatocyte steatosis， the patients were divided into simple AIH group and fatty liver group. The differences in body mass index（BMI）， fasting blood glucose， cholesterol， triglycerides， liver function， liver fibrosis were compared between the two groups were compared. The independent risk factors for AIH and hepatic steatosis were screened. Results A total of 80 patients were enrolled in this study， and there were 23 with hepatic steatosis and the incidence was 28.75%， similar to the general population. Among them， 22 were women， accounting for 95.7%， and 17 were between the age of 50 and 70， accounting for 73.9% of the total. The hepatic inflammation index in patients with hepatic steatosis was significantly higher than that in AIH patients（P<0.05）. There was no significant difference in liver fibrosis indexes between the two groups（P>0.05）. The BMI， fasting blood glucose， triglyceride and total cholesterol in patients with hepatic steatosis were significantly higher than those in simple AIH patients（P<0.05）. Further regression analysis showed that fasting glucose was an independent risk factor for hepatic steatosis in AIH patients. Conclusion The incidence of hepatic steatosis in patients with AIH is similar to that of the general population. The occurrence of hepatic steatosis is mainly related to the patient's own metabolic factors， and has no obvious relationship with the disease itself. Hepatocyte steatosis does not affect the progression of liver fibrosis in patients with AIH.

[Key words] Autoimmune hepatitis； Fatty liver； Incidence； Risk factors

自身免疫性肝炎（autoimmune hepatitis，AIH）是一种由异常免疫反应介导的针对自身肝细胞的慢性炎症反应，以血清自身抗体阳性、高免疫球蛋白血症等为特点，多见于中年女性，临床表现隐匿，起病缓慢，可逐步向肝硬化、肝衰竭进展，部分患者在发现时已经发展为肝硬化，亦有一部分患者可表现为急性肝炎甚至急性重型肝炎。随着自身抗体和肝活组织病理学检查的广泛开展，我国AIH患者检出率逐年增加。目前AIH已成为非病毒性肝病的重要组成部分，越来越受到我国消化和肝病学界专家和临床医师们的关注。

与此同时，近年来随着经济的发展和生活方式的改变，非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）发病率在逐年上升。……