摘要
背景部分慢性乙型肝炎病毒(HBV)感染者血清丙氨酸氨基转移酶(ALT)可以长期处于参考范围内或小于参考范围上限的2倍,但肝脏却出现了严重损伤甚至发生肝硬化和肝癌。目的分析ALT正常或者轻度异常的慢性HBV感染者肝脏病理组织的特征,探讨肝脏病理与临床的关系。方法选择2005—2012年在河北医科大学第二医院消化内科住院并行肝脏活组织检查的165例慢性HBV感染者,诊断依据为既往有乙型肝炎病史或HBV表面抗原(HBsAg)阳性超过6个月,现HBsAg和(或)HBV DNA仍为阳性者。分析ALT正常组(113例)和ALT轻度异常组(52例)肝脏病理表现与性别、年龄、HBV e抗原(HBeAg)及HBV DNA病毒载量之间的关系。结果 ALT正常组和ALT轻度异常组的年龄、性别构成间差异有统计学意义(t=2.12,χ2=15.92,P<0.01)。ALT正常组与ALT轻度异常组的肝组织炎症分级构成比和肝脏纤维化分期构成比比较,差异均有统计学意义(χ2=16.03,12.72,P<0.05)。ALT正常组的年龄与纤维化分期积分呈正相关(r=0.29,P<0.01)。ALT轻度异常组的年龄与炎症分级积分(r=0.38,P<0.01)和纤维化分期积分(r=0.51,P<0.01)均呈正相关。两组的病毒载量构成比间差异无统计学意义(χ2=1.74,P>0.05),ALT轻度异常组病毒载量与炎症分级积分呈负相关(r=-0.28,P<0.05)。结论 ALT轻度异常HBV感染者肝脏炎性损伤的易发因素包括年龄较大和HBeAg阴性。高病毒载量者反而肝组织炎性损伤较轻,这可能与免疫耐受有关。ALT正常或轻度异常的HBV感染者肝脏纤维化程度与年龄密切相关。适时的肝脏活组织穿刺检查对于鉴别ALT正常或者轻度异常的HBV感染者肝脏损伤至关重要。
Background The serum alanine aminotransferase （ALT） level in chronic hepatitis B virus （HBV） - in- fected patients may stay within the reference range or less than 2 times of the maximum reference value, yet serious damage even cirrhosis and cancer may happen to the liver. Objective To evaluate liver histopathology differences between HBV - infected pa- tients with normal and mildly abnormal ALT level, and analyze its relationship with basic clinical data. Methods HBV - infec- ted patients who were admitted to our department and underwent a liver biopsy between January 2005 and December 2012 were en- rolled. The diagnostic criteria for HBV infection included history of HBV infection or HBsAg positive for over 6 months, and cur- rent positive HBsAg and/or HBV DNA. Chronic HBV - infected patients were divided into normal - ALT and mildly - abnormal -ALT groups according to the serum ALT level. The pathological features, sex, age, HBeAg, and HBV DNA viral load were compared between the two groups. Results A total of 165 HBV - infected patients were divided into a normal - ALT group （ n = 113 ） and a mildly - abnormal - ALT group （ n = 52） based on the serum ALT level. The age and sex ratio were significantly dif- ferent between the two groups （ t = 2. 12, X2 = 15. 92, P 〈 0. 01 ）. The constitute ratio of liver inflammation grading and fibrosis staging were also significantly different between the two groups （ X2 = 16. 03, 12.72, P 〈 0. 05 ）. In normal - ALT group, agewas positively correlated with fibrosis staging score （ r = 0. 29, P 〈 0.01 ）. In mildly - abnormal - ALT group, age was positively correlated with inflammation grading score （ r =0. 38, P 〈0. 01 ） and fibrosis staging score （ r = 0. 51, P 〈 0.01 ）. No signifi- cant differences were observed in the constitute ratio of the HBV DNA viral load between the two groups （ x2 = 1.74, P 〉 0.05 ）. In mildly - abnormal - ALT group, HBV DNA viral load was negatively correlated with inflammation grading score （ r = - 0. 28, P 〈 0.05）. Conclusion Risk factors for liver inflammatory injury in HBV - infected patients with mildly abnormal ALT include older age and HBeAg negative. High HBV DNA viral load with less serious inflammatory injury in liver tissue may be related to immune tolerance. Liver fibrosis in HBV - infected patients with normal or mildly abnormal ALT is closely related to age. Timely liver biopsy is essential to identify liver damage in chronic HBV - infected patients with normal or mildly abnormal ALT.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第14期1603-1606,共4页
Chinese General Practice
基金
国家自然科学基金资助项目(81200311,81170411)
