急性病毒性肝炎患者血脂、血糖、蛋白、尿酸变化特点及其与预后的关联

doi:10.3877/cma.j.issn.2095-2015.2024.05.003

目的

分析急性病毒性肝炎患者血脂、血糖、蛋白、尿酸变化特点及其与预后的关联。

方法

纳入徐州医科大学附属徐州市立医院2020年1月至2023年1月收治的100例急性病毒性肝炎患者为试验组，选取同期60例健康体检者为对照组，比较试验组与对照组入院时血脂、血糖、蛋白、尿酸、凝血酶原活动度（PTA）差异。试验组治疗8周后，根据预后，将其分为预后良好组、预后不良组，比较2组患者上述指标差异，总结上述指标与患者肝功能及预后的关联。

结果

试验组谷丙转氨酶（ALT）、谷草转氨酶（AST）和总胆红素（TBIL）；甘油三酯（TG）、空腹血糖（FPG）；总蛋白（TP）、尿酸均高于对照组，总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、前白蛋白（PA）、白蛋白（ALB）均低于对照组（P<0.05）。治疗后试验组100例患者中，71例达到治愈标准，21例预后不良。预后良好组ALT、AST、TBIL和TG、FPG、TP、尿酸均低于对照组，TC、HDL-C、LDL-C、ALB、PA、PTA高于对照组（P<0.05）。

结论

部分急性病毒性肝炎患者预后不理想，与入院时血脂、血糖、蛋白、尿酸水平显著异常有关，且上述指标异常的加剧往往伴随着肝功能显著损伤。

关键词: 急性病毒性肝炎, 血脂, 尿酸, 预后

Objective

To analyze the changes of blood lipid, blood glucose, protein and uric acid in patients with acute viral hepatitis and their correlation with prognosis.

Methods

A total of 100 patients with acute viral hepatitis admitted to the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University from January 2020 to January 2023 were included in the experimental group, and 60 healthy people in the same period were selected and included in the control group. The differences of blood lipid, blood glucose, protein, uric acid and prothrombin activity (PTA) between the experimental group and the control group were compared. According to the prognosis of the experimental group after 8 weeks of treatment, the patients were divided into good prognosis group and poor prognosis group respectively. The differences of the above indexes between the two groups were compared, and the correlation between the above indexes and the liver function and prognosis of the patients was summarized.

Results

Alanine aminotransferase (ALT), glutamic oxaloacetic transaminase (AST), total bilirubin (TBIL), triglyceride (TG), fasting blood-glucose (FPG), total protein (TP) and uric acid in the experimental group were higher than those in the control group, while total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), prealbumin (PA) and albumin (ALB) were lower than those in the control group (P<0.05). Among 100 patients in the experimental group, 71 cases reached the cure standard, and 21 cases had poor prognosis. ALT, AST, TBIL, TG, FPG, TP and uric acid in the good prognosis group were lower than those in the control group, while TC, HDL-C, LDL-C, ALB, PA and PTA were higher than those in the control group (P<0.05).

Conclusion

The prognosis of some patients with acute viral hepatitis is not ideal, which is related to the remarkable abnormality of blood lipid, blood glucose, protein and uric acid at admission, and the aggravation of the above indexes is often accompanied by the remarkable damage of liver function.

Key words: Acute viral hepatitis, Blood lipids, Uric acid, Prognosis

表1 2组临床资料比较

组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	性别[例(%)]		文化水平[例(%)]
组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	男	女	高中及以下	高中以上
试验组	100	61.33±7.59	23.50±1.38	55(55.00)	45(45.00)	61(61.00)	39(39.00)
对照组	60	61.26±7.84	23.41±1.26	34(56.67)	23(38.33)	36(60.00)	24(40.00)
t/χ²值		0.056	0.412	0.042		0.016
P值		0.956	0.681	0.837		0.900

表1 2组临床资料比较

组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	性别[例(%)]		文化水平[例(%)]
组别	例数	年龄(岁,±s)	体重指数(kg/m²,±s)	男	女	高中及以下	高中以上
试验组	100	61.33±7.59	23.50±1.38	55(55.00)	45(45.00)	61(61.00)	39(39.00)
对照组	60	61.26±7.84	23.41±1.26	34(56.67)	23(38.33)	36(60.00)	24(40.00)
t/χ²值		0.056	0.412	0.042		0.016
P值		0.956	0.681	0.837		0.900

表2 2组肝功能、血脂、蛋白等实验室指标比较（

±s）

组别	例数	ALT(U/L)	AST(U/L)	TBIL(μmol/L)	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)
试验组	100	1266.83±157.96	482.89±31.57	95.66±16.99	3.61±0.57	2.28±0.26	0.65±0.11	1.96±0.35
对照组	60	17.95±2.38	19.24±2.19	12.31±1.64	4.74±0.88	1.05±0.13	1.33±0.23	2.53±0.49
t值		61.160	113.454	37.847	9.858	34.143	25.186	8.556
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	FPG(mmol/L)	TP(g/L)	PA(g/L)	ALB(g/L)	尿酸(μmol/L)	PTA(%)
试验组	100	9.55±0.16	73.59±6.08	211.54±11.39	38.16±1.99	326.27±14.26	65.26±6.69
对照组	60	5.13±0.74	68.61±5.71	259.88±12.53	40.41±2.48	252.59±11.58	85.33±11.73
t值		57.638	5.130	25.026	6.303	33.867	10.478
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表2 2组肝功能、血脂、蛋白等实验室指标比较（

±s）

组别	例数	ALT(U/L)	AST(U/L)	TBIL(μmol/L)	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)
试验组	100	1266.83±157.96	482.89±31.57	95.66±16.99	3.61±0.57	2.28±0.26	0.65±0.11	1.96±0.35
对照组	60	17.95±2.38	19.24±2.19	12.31±1.64	4.74±0.88	1.05±0.13	1.33±0.23	2.53±0.49
t值		61.160	113.454	37.847	9.858	34.143	25.186	8.556
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	FPG(mmol/L)	TP(g/L)	PA(g/L)	ALB(g/L)	尿酸(μmol/L)	PTA(%)
试验组	100	9.55±0.16	73.59±6.08	211.54±11.39	38.16±1.99	326.27±14.26	65.26±6.69
对照组	60	5.13±0.74	68.61±5.71	259.88±12.53	40.41±2.48	252.59±11.58	85.33±11.73
t值		57.638	5.130	25.026	6.303	33.867	10.478
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表3 预后良好组与预后不良组入院时肝功能、血脂、蛋白等实验室指标比较（

±s）

组别	例数	ALT(U/L)	AST(U/L)	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)	TP(g/L)
预后良好组	71	1266.83±124.38	482.89±22.49	3.98±0.36	1.76±0.19	0.85±0.06	2.14±0.39	71.99±3.54
预后不良组	29	1531.51±139.61	602.81±26.53	2.70±0.29	3.55±0.20	0.16±0.03	1.52±0.31	77.51±4.18
t值		9.316	22.946	17.009	42.104	58.870	7.626	6.708
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	PA(g/L)	ALB(g/L)	尿酸(μmol/L)	PTA(%)	FPG(mmol/L)	TBIL(μmol/L)
预后良好组	71	226.83±9.26	39.05±5.97	301.38±11.75	72.19±8.25	8.54±0.11	95.66±11.48
预后不良组	29	174.11±8.71	35.98±8.81	387.21±13.69	48.29±7.03	12.02±0.29	143.21±13.69
t值		26.270	2.018	31.573	13.692	87.362	17.755
P值		<0.001	0.046	<0.001	<0.001	<0.001	<0.001

表3 预后良好组与预后不良组入院时肝功能、血脂、蛋白等实验室指标比较（

±s）

组别	例数	ALT(U/L)	AST(U/L)	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)	TP(g/L)
预后良好组	71	1266.83±124.38	482.89±22.49	3.98±0.36	1.76±0.19	0.85±0.06	2.14±0.39	71.99±3.54
预后不良组	29	1531.51±139.61	602.81±26.53	2.70±0.29	3.55±0.20	0.16±0.03	1.52±0.31	77.51±4.18
t值		9.316	22.946	17.009	42.104	58.870	7.626	6.708
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	PA(g/L)	ALB(g/L)	尿酸(μmol/L)	PTA(%)	FPG(mmol/L)	TBIL(μmol/L)
预后良好组	71	226.83±9.26	39.05±5.97	301.38±11.75	72.19±8.25	8.54±0.11	95.66±11.48
预后不良组	29	174.11±8.71	35.98±8.81	387.21±13.69	48.29±7.03	12.02±0.29	143.21±13.69
t值		26.270	2.018	31.573	13.692	87.362	17.755
P值		<0.001	0.046	<0.001	<0.001	<0.001	<0.001

[1]	方芳, 李爽, 刁玲玲, 等. 病毒性肝炎患者肝活体组织检查后心理危机状况及相关因素[J]. 中国医药导报, 2022, 19(29): 81-84.
[2]	Tu C M, Wei T E, Tseng G S, et al. Serum uric acid is associated with incident metabolic syndrome independent of body shape index and body roundness index in healthy individuals[J]. Nutr Metab Cardiovasc Dis, 2021, 31(11): 3142-3151.
[3]	Wang M, Chen W Y, Zhang J, et al. Elevated fructose and uric acid through aldose reductase contribute to experimental and human alcoholic liver disease[J]. Hepatology, 2020, 72(5): 1617-1637.
[4]	王立蓉, 俞谦, 孟桂霞, 等. 老年病毒性肝炎病人继发肝硬化危险因素分析[J]. 实用老年医学, 2020, 34(6): 558-561.
[5]	Lin S, Zhang T, Zhu L, et al. Characteristic dysbiosis in gout and the impact of a uric acid-lowering treatment, febuxostat on the gut microbiota[J]. J Genet Genomics, 2021, 48(9): 781-791.
[6]	王川雨, 陈奕君, 林尤直. 影响索非布韦联合雷迪帕韦治疗丙型病毒性肝炎疗效的因素及其预测价值研究[J]. 中国临床药理学杂志, 2020, 36(7): 741-743, 759.
[7]	盛秋菊, 韩超, 丁洋, 等. 慢性乙型肝炎抗病毒治疗与疾病长期预后——慢性乙型肝炎防治指南(2019年版)更新要点解读[J]. 中国实用内科杂志, 2020, 40(6): 441-445.
[8]	Qu J, Dou J, Wang A, et al. Fatty liver index for hyperuricemia diagnosis: a community-based cohort study[J]. BMC Endocrine Disorders, 2022, 22(1): 1-9.
[9]	Borghi C, Domienik-Karłowicz J, Tykarski A, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk: 2021 update[J]. Cardiol J, 2021, 28(1): 1-14.
[10]	杨小兵, 邹娇娇, 陈邦华, 等. 2004-2017年武汉市病毒性肝炎流行病学特征分析[J]. 中国预防医学杂志, 2019, 20(1): 42-47.
[11]	Katsiki N, Dimitriadis GD, Mikhailidis DP. Serum uric acid and diabetes: from pathophysiology to cardiovascular disease[J]. Current Pharmaceutical Design, 2021, 27(16): 1941-1951.
[12]	杨甲, 饶慧瑛. 中国丙型病毒性肝炎流行趋势及治疗获益[J]. 临床药物治疗杂志, 2021, 19(12): 6-11.
[13]	Zhang Y, Pan R, Xu Y, et al. Treatment of refractory gout with TNF-α antagonist etanercept combined with febuxostat[J]. Ann Palliat Med, 2020, 9(6): 4332-4338.
[14]	虞接军, 刘中夫, 李健. 慢性丙型病毒性肝炎患者健康相关生命质量的研究进展[J]. 中国艾滋病性病, 2023, 29(2): 230-233.
[15]	Chao G, Chen L. Study on the independent effect of thyroid hormone based on uric acid level on NAFLD[J]. J Heal Popul Nutr, 2021, 40(1): 1-7.
[16]	薛红, 姚敏, 岳明, 等. 303例丙型病毒性肝炎患者的生化特征分析[J]. 东南国防医药, 2019, 21(5): 455-459.
[17]	刘沁雨, 常越, 张青, 等. 血清尿酸对非酒精性脂肪性肝病进展期肝纤维化/肝硬化的诊断价值[J/OL]. 中华肝脏病杂志(电子版), 2020,12(1):24-30.
[18]	Zeng H, Tang C, Lin B, et al. The regulation effect of GLUT9/SLC2A9 on intrahepatic uric acid level and metabolic associated fatty liver disease[J]. Hepatol Int, 2022, 16(5): 1064-1074.
[19]	Feng Y, Zheng S, Liu L, et al. Association of serum uric acid with hepatic steatosis detected by controlled attenuation parameter in the United States population[J]. Lipids Health Dis, 2023, 22(1): 1-8.
[20]	Wang J, Abdus S, Tan C, et al. Serum uric acid level negatively correlated with the prevalence of clopidogrel low response in patients undergoing antiplatelet treatment with aspirin and clopidogrel[J]. Nutr Metabol Cardiovasc Dis, 2020, 30(12): 2215-2220.
[21]	Zhang X, Cui J, Hou J, et al. Research Progress of Natural Active Substances with Uric-Acid-Reducing Activity[J]. J Agric Food Chem, 2022, 70(50): 15647-15664.
[22]	Peng L, Wu S, Zhou N, et al. Clinical characteristics and risk factors of nonalcoholic fatty liver disease in children with obesity[J]. BMC Pediatrics, 2021, 21(1): 1-8.
[23]	Khan JUA, Fayaz H, Wahab A, et al. Association Between Serum Uric Acid and Nonalcoholic Fatty Liver Disease: A Case Control Study[J]. Pak J Med Heal Sci, 2023, 17(2): 662-662.
[24]	Jang TY, Huang CI, Yeh ML, et al. Improvement of hyperuricemia in chronic hepatitis C patients receiving directly acting antiviral agents[J]. J Gastroenterol Hepatol, 2020, 35(3): 473-481.
[25]	Zhou Y, Li W, Huang Y. A low serum uric acid concentration predicts a poor prognosis in adult patients with candidemia[J]. Open Med, 2022, 17(1): 1077-1083.

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Changes of blood lipid, blood glucose, protein and uric acid in patients with acute viral hepatitis and their correlation with prognosis

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Changes of blood lipid, blood glucose, protein and uric acid in patients with acute viral hepatitis and their correlation with prognosis