摘要
目的观察谷丙转氨酶(ALT)水平持续正常的慢性乙型肝炎病毒(HBV)感染者的肝脏病理特征,分析影响肝脏炎症和肝纤维化的危险因素,明确抗病毒治疗的准确时机。方法回顾性分析2020年9月至2022年1月于深圳市中西医结合医院住院的150例血清ALT水平持续低于正常值上限(ULN)的慢性HBV感染者的临床资料,对所有研究对象的肝脏病理结果和实验室检测结果进行统计分析,采用单因素分析和多因素回归分析影响患者发生明显肝脏炎症(G≥2)或纤维化(S≥2)的危险因素。结果93例(62.0%)患者的肝组织G≥2级或S≥2级。单因素分析显示,ALT>25U/L、谷氨酰转肽酶(GGT)>20U/L、前白蛋白(PA)≤230g/L、血小板(PLT)计数≤160×10^(9)/L、部分活化凝血酶原时间(APTT)>28s是ALT水平持续正常的慢性HBV感染者肝脏病理发生G≥2或S≥2的危险因素(P<0.05);二分类逻辑回归的多因素分析显示,ALT>25U/L、PLT计数≤160×10^(9)/L、APTT>28s是ALT水平持续正常的慢性HBV感染者肝脏病理发生G≥2或S≥2的独立危险因素。结论对于ALT<ULN的慢性HBV感染者,ALT、PLT和APTT水平可作为预测肝脏组织发生明显病变的独立危险因素和抗病毒治疗的依据。
Objective To investigate the feature of liver pathology in chronic HBV patients with normal level of alanine aminotransferase(ALT),to analyze the risk factors of liver inflammation and fibrosis,to determine the exact timing of antiviral treatment.Method The clinical data of 150 patients with chronic HBV infection with normal level of serum ALT in Shenzhen Hospital of Integrated Traditional And Western Medicine from September 2020 to January 2022 were retrospectively collected and the liver pathological results of all subjects were statistically analyzed.Univariate analysis and multivariate regression were used to analyze the risk factors for significant liver inflammation(G≥2)or fibrosis(S≥2).Result The pathological examination of liver tissue reveal G≥2 or S≥2 in 93 cases(62.00%).Univariate analysis showed that ALT>25U/L,glutamyl transpeptidase(GGT)>20U/L,prealbumin(PA)≤230g/L,platelet(PLT)count≤160×10^(9)/L,partial activated prothrombin time(APTT)>28s were the possible risk factors for liver pathology G≥2 or S≥2 in chronic HBV patients with normal level of ALT(P<0.05);Multivariate analysis of binary logistic regression showed that ALT>25U/L,PLT count≤160×10^(9)/L and APTT>28s were independent risk factors for liver pathology G≥2 or S≥2 in chronic HBV patients with normal level of ALT.Conclusion ALT level,PLT level and APTT level can be used as the basis for judging the severity of liver pathology and receiving antiviral therapy in chronic HBV infected patients with normal level of ALT.
作者
李延东
范荣山
Li Yandong;Fan Rongshan(Pathology Department of Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,0Guangdong Shenzhen 518104,China;Hepatic Department of Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Guangdong Shenzhen 518104,China)
出处
《新发传染病电子杂志》
2023年第1期44-47,共4页
Electronic Journal of Emerging Infectious Diseases
关键词
慢性乙型肝炎
肝脏病理
谷丙转氨酶
预测因素
Chronic hepatitis B
Liver pathology
Alanine aminotransferase
Predictive factors
