嚼食檳榔為脂肪肝之危險因子－以台灣東部鄉村地區慢性C型肝炎患者為研究對象

Betel Quid Chewing as A Risk Factor of Hepatic Steatosis in Patients with Chronic Hepatitis C in A Rural Area of East Taiwan

鄭穆良(Mu-Liang Cheng) ； 林軒毓(Hsuan-Yu Lin)

《內科學誌》 31卷6期 (2020/12) Pp. 425-431

https://doi.org/10.6314/JIMT.202012_31(6).06

摘要

台灣東部C型肝炎感染流行的鄉村地區，代謝疾病和過量飲酒等健康問題也相對普遍，居民暴露於脂肪肝的高風險之中，但是缺乏相關研究資料。肝臟纖維化掃描為一非侵入性的檢查，可同時提供肝臟纖維化和脂肪肝程度之定量評估，並與組織切片的結果高度一致。本研究為一橫斷面研究，目的在於透過肝纖維化掃描，評估台灣東部鄉村地區慢性C型肝炎患者重度脂肪肝的發生頻率和相關因子。重度脂肪肝的定義為肝纖維化掃描CAP值（controlled attenuation parameter）≥ 290 dB/m。共有47位病患被納入研究（男性佔30％；平均年齡67 ± 10歲），過重和肥胖者佔83％，嚼食檳榔者則佔30％。其中，有40％出現重度以上肝纖維化，45％出現重度脂肪肝變化。相關性分析顯示，過重和肥胖與重度脂肪肝高度相關（p=0.006）。過重和肥胖者若同時有嚼食檳榔的習慣，將有更高的風險患有重度脂肪肝（p=0.034; OR=6.76;95％ CI=1.15-40.00）。本研究主要結論為：在台灣東部鄉村地區，慢性C型肝炎患者有極高的脂肪肝盛行率，其程度也較為嚴重；在過重和肥胖的次族群中，嚼食檳榔是重度脂肪肝的獨立危險因子。因此，為避免脂肪肝的惡化，不但要積極減重，同時應戒除嚼食檳榔的習慣。

關鍵字

慢性C型肝炎（Chronic hepatitis C） ； 脂肪肝（Hepatic steatosis） ； 肝纖維化掃描（Fibroscan） ； 過重（Overweight） ； 肥胖（Obesity） ； 檳榔（Betel quid）

並列摘要

In some rural area of East Taiwan with high prevalence of chronic hepatitis C, metabolic disorders and heavy alcohol use are also common. The residents were exposed to high risk of hepatic steatosis. As a non-invasive tool for quantifying hepatic steatosis and fibrosis, transient elastography (known as Fibroscan) examination is highly correlated to the result of liver biopsy. The aims of this cross-sectional study were to estimate the prevalence and associated factors of severe steatosis in chronic hepatitis C patients in a rural area of East Taiwan. Severe steatosis was defined as CAP (controlled attenuation parameter)≥ 290 dB/m by Fibroscan examination. 47 adults with chronic hepatitis C infection were included (30% male; mean age 67 ± 10 years). The frequency of overweight/obesity and betel quid chewing were 83% and 30% respectively. Severe fibrosis/cirrhosis was identified in 40% of patients and severe steatosis was observed in 45%. Overweight/obesity was associated with sever steatosis (p=0.006). In patients with overweight/obesity, concomitant chewing of betel quid further increased the risk of severe steatosis(p=0.034; OR=6.76; 95% CI=1.15-40.00). In conclusion, chronic hepatitis C patients in a rural area of East Taiwan presented a high prevalence of severe steatosis. Among the subgroup with overweight and obesity, betel quid chewing is an independent risk factor of severe steatosis. Except for weight reduction, to quit betel quid chewing may be important to avoid deterioration of hepatic steatosis in the chronic hepatitis C patient with overweight.