男性B型肝炎帶原者脂肪肝與血糖控制之縱貫性研究：臺灣公保健診中心世代初步分析

背景與研究目標過去較少對於亞洲所盛行的慢性B型肝炎病毒感染者研究血糖控制中脂肪肝所扮演角色的數據。本研究旨在慢性B型肝炎病毒感染男性的世代中，做初步縱式分析來探討脂肪肝持續性與血糖控制的關係。材料與方法　　本研究使用1989年至1992年在公保健診中心接受免費健康檢查的2878名B型肝炎表面抗原(hepatitis B surface antigen; HBsAg)陽性男性個案(進入研究時年齡為30至76歲)。在這些B型肝炎病毒帶原者中，納入本研究分析的為604位在2005至2009年間至少有來兩次健康檢查的無肝硬化的HBsAg陽性個案。脂肪肝是由腹部超音波來診斷，並根據第一次和最後一次測量時的圖像證據變化分為四個組別：兩次皆無、新發個案、轉歸無、持續有脂肪肝。血糖的部分根據世界衛生組織分為正常、空腹血糖異常(impaired fasting glucose; IFG)、糖尿病(diabetes mellitus; DM)，切點分別為＜100、100 - 125、≧126 mg/dL，也將問卷填答有無糖尿病一同定義。人口學資料、糖尿病家族史、飲酒與抽菸習慣是以標準化問卷訪問而來。每次來檢時測量身體質量指數(body mass index)、血壓、血清脂質水平及肝臟酵素。使用多變項羅吉斯回歸(multivariate logistic regression)來看脂肪肝與空腹血糖異常或糖尿病之風險比(odds ratio; OR)。結果　　在首次來檢時，平均年齡為61.7歲，年齡中位數為61歲。IFG及DM盛行率分別為10.9%及11.6% 。有脂肪肝的圖像證據者有236人(占604人當中的39.1%)。在平均追蹤3.2年期間，有54位(8.9%)新發脂肪肝個案，65位(10.8%)轉歸無脂肪肝者、171位(28.3%)持續有脂肪肝者。在單變項分析的部分，持續有脂肪肝與血糖升高(IFG或DM)有相關，相較於兩次皆無脂肪肝者其風險比(OR)為2.16 (95% 信賴區間=1.32-3.52，p值=0.0021)。經校正了首次來檢時年齡、BMI、三酸甘油脂、總膽固醇、高密度脂蛋白、收縮壓後，此關係仍存在，多變項校正後風險比(OR)為2.00 (95%信賴區間=1.08-3.72，p值=0.0277)。結論　　HBV帶原者持續有脂肪肝者相較於兩次檢查均無脂肪肝者，有較高的風險產生IFG或DM。

關鍵字

脂肪肝；血糖； B型肝炎帶原者

並列摘要

Abstract Background Aims Few data exist regarding the role of fatty liver in glycemic control among individuals with chronic hepatitis B virus infection (HBV), which is prevalent in Asia-Pacific regions. This study aimed to conduct a preliminary analysis to evaluate the longitudinal relationship between persistence of fatty liver and glycemic control in a cohort of men with chronic HBV infection. Methods Data were obtained from a cohort of 2878 male, hepatitis B surface antigen-positive government employees (aged 30-65 years) who were recruited during free physical examination between 1989 and 1992. Of these HBV carriers, 604 who attended at least two check-up examinations between 2005 and 2009, and without liver cirrhosis were included for the present study. Fatty liver status was diagnosed by abdominal ultrasound and classified into four groups based on the image evidence at first and last measurement: none, developed, regressed, and persistence. According to World Health Organization criteria, fasting plasma glucose values of ＜100 , 100-125, and ≧126 mg/dL were defined normal, impaired fasting glucose (IFG), and diabetes mellitus (DM) , respectively. Demographics, history of diabetes mellitus, and habits of alcohol consumption and smoking were collected through standardized questionnaire interview. Body mass index, blood pressure, serum lipid levels, and liver enzymes were measured at each visit. Multivariate logistic regression was used to determine the odds ratio (OR) for fatty liver associated with IFG or DM. Results At first visit, the mean (median) age of study participants was 61.7 (61.0) years. The prevalence of IFG and DM was 10.9% and 11.6%, respectively. There were 236 of the 604 participants (39.1%) had image evidence of fatty liver. During the mean follow-up period of 3.2 years, we observed 54 (8.9%) new cases of fatty liver, and regression of fatty liver was found in 65 (10.8%). 171 (28.3%) had persistent fatty liver. In univariate analysis, persistence of fatty liver was associated with elevated blood sugar (IFG or DM), showing an OR of 2.16 (95% CI=1.32-3.52, p=0.0021), when comparing participants with persistent fatty liver with those without. This association remained statistically significant even after adjustment for age at first visit and body mass index, triglyceride (TG), total cholesterol, high density lipoprotein (HDL) and systolic blood pressure (SBP) change. The multivariate-adjusted OR was 2.00 (95% CI=1.08-3.72, p=0.0277). Conclusions 　　 Persistent fatty liver in HBV carriers have higher risk to develop IFG or DM, when comparing with those without fatty liver.

並列關鍵字

fatty liver ； glucose ； hepatitis B virus carrier

參考文獻

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