ABSTRACT
ObjectiveTo investigate the virological features of patients with chronic hepatitis B （CHB） and metabolic associated fatty liver disease （MAFLD） through a stratified analysis. MethodsA retrospective analysis was performed for 131 patients with CHB and MAFLD and 168 patients with CHB alone who underwent percutaneous liver biopsy and did not receive antiviral therapy or withdrew from drugs for more than 6 months in Beijing YouAn Hospital， Capital Medical University， from January 1， 2013 to December 31， 2019. The two groups were compared in terms of general data， biochemical parameters， and virological parameters. The patients in the two groups were stratified according to liver inflammation grade （G） and liver fibrosis stage （S）， and the patients with CHB and MAFLD were further analyzed based on the degree of hepatic steatosis and NAFLD activity score （NAS）. Virological features （the serum levels of HBV DNA and HBV HBsAg） were compared between groups. The Wilcoxon test was used for comparison of continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups； the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the CHB group， the CHB+MAFLD group had a significantly higher proportion of male patients， a significantly higher proportion of patients with hypertension or type 2 diabetes mellitus， and significantly higher levels of the blood biochemical parameters of triglyceride， low-density lipoprotein cholesterol， apolipoprotein B， alanine aminotransferase， gamma-glutamyl transpeptidase， uric acid， and fasting blood glucose （all P<0.05）， as well as significantly lower levels of high-density lipoprotein cholesterol， apolipoprotein A1， and HBV DNA （all P<0.05）. The stratified analysis based on liver fibrosis stage showed that for both the patients with CHB alone and those with CHB and MAFLD， the significant fibrosis （S2 — 4） group had a significantly lower level of HBV DNA than the non-significant fibrosis （S0 — 1） group （P<0.05）， and for the patients with CHB alone， the significant fibrosis （S2 — 4） group had a significantly lower level of HBsAg than the non-significant fibrosis （S0 — 1） group （P<0.05）. The stratified analysis based on inflammation grade showed that for the patients with CHB and MAFLD， the high inflammation grade （G3） group had a significantly higher level of HBV DNA than the low inflammation grade （G1 — 2） group （P<0.05）， and in the low inflammation grade （G1 — 2） group， the patients with CHB and MAFLD had a significantly lower level of HBsAg than the patients with CHB alone （P<0.05）. The stratified analysis based on the degree of hepatic steatosis showed that the level of HBV DNA gradually decreased with the increase in the degree of steatosis， and the severe steatosis group had a significantly lower level of HBV DNA than the mild group （P<0.05）， while there was no significant difference in HBsAg level between the groups with different degrees of hepatic steatosis （P>0.05）. The stratified analysis based on NAS score showed that the NAS≥4 group had significantly higher levels of HBV DNA and HBsAg than the NAS<4 group （both P<0.05）. ConclusionPatients with CHB and MAFLD have significant abnormalities in metabolic markers and aminotransferases， while virological indicators show different features in stratified analyses based on various indicators.
ABSTRACT
Objective:To investigate the effect of rehabilitation exercise combined with resistance training on the postoperative recovery and quality of life among patients with pulmonary nodules.Methods:A randomized controlled study was conducted on 90 patients with pulmonary nodules who underwent thoracoscopic resection of pulmonary nodules at Zhejiang Veteran Hospital between January 2022 and April 2023. Patients were randomly allocated into an observation group and a control group, with 45 patients in each group using the random number table method. The control group underwent routine rehabilitation exercise, whereas the observation group received resistance training combined with routine rehabilitation exercise. All patients were treated for 1 week. The incidence of postoperative complications and the changes in lung function, exercise endurance, and quality of life from baseline levels were compared between the two groups.Results:The incidence of postoperative complications in the observation group was significantly lower than that in the control group [6.7% (3/45) vs. 24.4% (11/45), χ2 = 5.41, P = 0.020). After intervention, the forced expiratory volume in 1 second, maximal voluntary ventilation per minute, and forced vital capacity in the observation group were (83.84 ± 4.35)%, (96.53 ± 3.45) L/min, and (2.87 ± 0.16) L, respectively, which were higher than those in the control group [(78.98 ± 4.01)%, (92.13 ± 3.08) L/min, (2.62 ± 0.19) L, t = -5.51, -6.38, -6.75, all P < 0.001]. Additionally, the modified Medical Research Council dyspnea score in the observation group was (0.42 ± 0.13) points, which was significantly lower than that in the control group [(0.87 ± 0.19) points, t = 13.11, P < 0.001). The modified Barthel index score in the observation group was significantly higher than that in the control group [(89.53 ± 3.67) points vs. (82.94 ± 4.23) points, t = -7.89, P < 0.001). Conclusion:The combination of rehabilitation exercise and resistance training can effectively enhance lung function, exercise endurance, and overall quality of life in patients with pulmonary nodules. Furthermore, this combined therapy markedly reduces postoperative complications.