慢性B型肝炎病毒感染、慢性C型肝炎病毒感染與代謝症候群、心血管疾病危險之研究

Serum hepatitis B virus antibody or hepatitis C virus antibody associated with the risks of metabolic syndrome and cardiovascular diseases.

李芳宇(Fang-Yu Li)

指導教授 ： 白其卉

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00086

摘要

研究背景：慢性B型、C型肝炎病毒感染與脂質代謝異常及胰島素阻抗有關，慢性病毒感染所造成之反覆且持續的發炎反應也與動脈粥狀硬化及心血管疾病有關。本研究欲探討慢性B型、C型肝炎病毒感染與代謝症候群、血脂異常、血糖異常的關連性，並進一步分析其全死因、心血管疾病及肝癌的死亡風險。

材料方法：本研究分為橫斷研究及縱貫研究兩部分。橫斷研究是利用美兆集團30,000人健檢資料。當HBsAg檢測結果呈陽性者即定義為慢性B型肝炎病毒感染(n=8,157)、anti-HCV檢測結果呈陽性者即定義為慢性C型肝炎病毒感染(n=789)。以線性迴歸及邏輯式迴歸分別探討慢性B型、C型肝炎病毒感染與代謝症候群、血脂異常、血糖異常的關連性。縱貫研究則是將美兆集團所提供之30,000人健檢資料與行政院衛生署2000-2008年死亡檔作勾稽，依ICD-9疾病碼將死亡原因分為全死因、心血管疾病及肝癌三大類，使用存活分析分別探討慢性B型、C型肝炎病毒感染其全死因、心血管疾病及肝癌的死亡風險。

結果：慢性B型肝炎病毒感染者其空腹血糖、三酸甘油酯及總膽固醇濃度較未感染者低，高密度脂蛋白膽固醇濃度較未感染者高，發生代謝症候群、高血脂危險、血脂異常、高血糖危險、血糖異常的危險性都較未感染者顯著地低(OR皆< 1 , p<0.05)，發生全死因及肝癌的死亡風險分別為未感染者的1.38及5.92倍(p<0.05)，心血管疾病的死亡風險為0.93倍(p>0.05)。慢性C型肝炎病毒感染者其空腹血糖較未感染者高，三酸甘油酯、總膽固醇及高密度脂蛋白膽固醇濃度較未感染者顯著地低，發生代謝症候群、高血脂危險、血脂異常的危險性都較未感染者低(OR皆<1 , p<0.05)，發生全死因及肝癌的死亡風險分別為未感染者的2.26及9.40倍(p<0.05)，心血管疾病的死亡風險為1.22倍(p>0.05)。
結論：本研究結果顯示，雖然慢性B型肝炎病毒感染者與心血管疾病、動脈粥狀硬化相關疾病的死亡風險無關，但是其發生代謝症候群、高血脂危險、血脂異常、高血糖危險、血糖異常的危險性都較未感染者顯著地低。慢性C型肝炎病毒感染其發生代謝症候群、高血脂危險及血脂異常的危險性都較未感染者顯著地低，但其他如：發生高血糖危險、血糖異常的危險性及心血管疾病、動脈粥狀硬化相關疾病的死亡風險上皆未達顯著相關。

關鍵字

慢性B型肝炎病毒感染 ； 慢性C型肝炎病毒感染 ； 代謝症候群 ； 心血管疾病

並列摘要

Background：Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are associated with abnormal lipid metabolism and insulin resistance (IR). In addition, chronic viral infection may cause persistent inflammation that have been associated with an increased risk of atherosclerosis and cardiovascular disease. The goal of our study is to investigate the relationships between metabolic syndrome, hyperlipidemia, hyperglycemia and HBV, HCV infection in Taiwanese. Additionally, we also aim to assess the mortalities of all cause, cardiac, and hepatoma among hepatitis B and C virus carriers in this population.

Materials and Methods：This data-base study contains two parts: a cross-sectional part and a longitudinal part. Cross-sectional design was used the datasets from 2000 to 2001 of the MJ Health Screening Center. Longitudinal design study was initiated since 2000, and the subjects were censored at the date of death attributable to all-cause or by December 31, 2008 if no censoring event occurred. Chronic HBV infection was defined as a positive result of HBV surface antigen (HBsAg). Chronic HCV infection was a positive result of anti-HCV antibody. Using linear regression and logistic regression to investigate the relationships between metabolic syndrome, hyperlipidemia, hyperglycemia and hepatitis B virus, hepatitis C virus infection. Cox proportional hazards model was used to assess the hazard ratios of mortality from all cause, cardiac, and hepatoma for HBsAg or anti-HCV seropositives compared with those seronegatives, respectively, after adjustment for age and gender.

Results：HBsAg seropositive subjects had a lower fasting glucose, triglyceride, total cholesterol levels and higher high-density lipoprotein cholesterol level compared with those never infected. Subjects with HBsAg seropositives were less likely to have metabolic syndrome, high lipid components, high glucose component, hyperlipidemia and hyperglycemia (all OR <1, p <0.05). After adjustment for age, gender and the competing risk of hepatic disease, the fully adjusted hazard ratios of mortality from cardiovascular disease were 0.93 (p> 0.05). Anti-HCV seropositives subjects had a lower triglyceride, total cholesterol and high-density lipoprotein cholesterol levels and higher fasting glucose level compared with those never infected. Also they were less likely to have metabolic syndrome, high lipid components and hyperlipidemia (all OR <1, p <0.05). The fully adjusted hazard ratios of mortality from cardiovascular disease were 1.22 (p> 0.05).

Conclusion：Although HBsAg seropositivity was not associated with increased death risks of cardiovascular/atherosclerosis-related diseases but they were less likely to have metabolic syndrome, high lipid components, high glucose component, hyperlipidemia and hyperglycemia. Even though anti-HCV seropositivity were less likely to have metabolic syndrome, high lipid components and hyperlipidemia, it also can’t not be a significant predictor for cardiovascular/atherosclerosis-related diseases.

並列關鍵字

Serum hepatitis B virus antibody ； Serum hepatitis C virus antibody ； Metabolic syndrome ； Cardiovascular diseases

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