高血糖对慢性乙型肝炎合并脂肪性肝病患者肝纤维化及终末期肝病的影响OA

Objective To analyze the clinicopathological features of patients with comorbidities of chronic hepatitis B(CHB)and steatotic liver disease(SLD),to investigate the impact of hyperglycemia on the risk of liver fibrosis and end-stage liver diseases(ESLD),and to provide a basis for the clinical management of such population.Methods A total of 668 adult patients with CHB-SLD confirmed by liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2011 to December 2019 were enrolled,and a retrospective cohort was established with the time of liver biopsy as the baseline and the onset of ESLD as the endpoint.All patients were followed up to March 31,2024.Propensity score matching(PSM)was performed at a ratio of 1∶4 to balance baseline features between groups,resulting in 82 patients in the hyperglycemia group and 281 in the non-hyperglycemia group.The two groups were compared in terms of metabolic profiles,laboratory markers,and histopathological features.The Mann-Whitney U test was used for comparison of non-normally distributed quantitative data between two groups.The chi-square test or Fisher exact test was used for comparison of categorical data between two groups.A multivariate Logistic regression analysis was used to investigate the influencing factors for advanced fibrosis(AF),and the Kaplan-Meier survival analysis and the Cox proportional-hazards regression model were used to determine the influencing factors for the development of ESLD.Results Compared with the non-hyperglycemia group,the hyperglycemia group had a significantly higher number of factors for metabolic disorders,a significantly higher degree of hepatic steatosis,and a significantly higher detection rate of AF(all P<0.05).The multivariate Logistic regression analysis showed that hyperglycemia was a risk factor for AF(odds ratio=1.753,95%confidence interval[CI]:1.017—3.023,P=0.043).The survival analysis showed that hyperglycemia increased the risk of ESLD(χ2=4.340,P=0.037).The multivariate Cox regression analysis confirmed that hyperglycemia was a significant metabolic risk factor for ESLD in patients with AF(adjusted hazard ratio=3.208,95%CI:1.201—8.568,P=0.020).Conclusion Hyperglycemia can increase the risk of AF and ESLD in CHB-SLD patients.Clinical monitoring and active management should be strengthened for patients who have already developed AF and hyperglycemia.