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ALT水平正常或轻度升高慢性乙型肝炎的肝组织学改变及临床特征分析
Liver histological changes and clinical features in chronic hepatitis B with normal or mildly elevated alanine aminotransferase
文章发布日期:2020年03月11日  来源:  作者:纪林秀,杨兴祥  点击次数:324次  下载次数:66次

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【摘要】:目的 研究ALT水平正常或轻度升高的慢性乙型肝炎(CHB)患者肝组织学改变与临床指标的关系,为指导抗病毒治疗提供依据。方法 回顾性收集四川省人民医院2011年10月-2018年8月行肝穿刺活检的CHB患者903例,比较性别、年龄、血清HBeAg状态、血清ALT、HBV DNA水平与ALT<2倍正常值上限(ULN)CHB患者肝脏炎症活动度和纤维化程度的关系,计数资料两组间比较采用χ2检验。结果 903例CHB患者肝脏炎症活动度分级在G1~G4之间,其中以G2为主,占67.6%,G≥2的患者有831例(92.0%);肝纤维化分期在S0~S4之间,以S1为主,占78.2%,S≥2的患者有159例(17.6%)。男性患者的肝脏炎症活动度分级和纤维化分期明显高于女性患者 (χ2=6.120、15.098,P值均<0.05)。ALT<1×ULN、1×ULN≤ALT<1.5×ULN、ALT≥15×ULN患者显著肝脏炎症坏死(G≥2)所占比例分别为91.2%、92.1%、94.8%,差异有统计学意义(χ2=28.125,P<0.05);三组患者的显著肝纤维化(S≥2)所占比例分别为12.7%、22.9%、24.4%,差异亦有统计学意义(χ2=18.004,P<0.05)。随着CHB患者年龄增大,肝脏炎症活动度和纤维化程度均加重,差异均有统计学意义(χ2=65.768、56.056,P值均<0.05)。随着血清HBV DNA水平降低,肝脏炎症活动度和纤维化程度均加重,差异均有统计学意义(χ2=21.712、29.461,P值均<0.05)。HBeAg阴性患者肝脏炎症活动度分级和纤维化分期均明显高于HBeAg阳性患者(χ2=30.798、26.380,P值均<0.05)。年龄≥30岁且1.5×ULN≤ALT<2×ULN的HBeAg阳性和HBeAg阴性患者显著肝脏炎症坏死的比例分别为100%(40/40)和97.8%(45/46)。结论 ALT水平正常或轻度升高的CHB患者中大多数具有显著的肝脏炎症和不同程度的肝纤维化,特别是年龄≥30岁的男性患者,建议完善肝组织病理学检查评估抗病毒治疗指征,以免延误治疗。
【Abstract】:Objective To investigate the association between liver histological changes and clinical indices in chronic hepatitis B (CHB) patients with normal or mildly elevated alanine aminotransferase (ALT), and to provide a basis for guiding antiviral therapy. Methods A retrospective analysis was performed for the clinical data of 903 CHB patients who underwent liver biopsy in Sichuan Provincial People’s Hospital from October 2011 to August 2018. The association of sex, age, serum HBeAg status, serum ALT, and HBV DNA level with liver inflammation activity and fibrosis degree was analyzed in CHB patients with an ALT level of <2×upper limit of normal (ULN). The chi-square test was used for comparison of categorical data between two groups. Results The liver inflammatory activity ranged from G1 to G4 in 903 CHB patients, among whom 67.6% had G2 inflammation and 831 (92.0%) had G≥2 inflammation; the fibrosis stage ranged from S0 to S4 in all patients, among whom 78.2% had S1 fibrosis and 159 (17.6%) had S≥2 fibrosis. Male patients had significantly higher liver inflammatory activity and fibrosis stage than the female patients (χ2=6.120 and 15.098, both P<0.05). Among the patients with ALT<1×ULN, 1×ULN≤ALT <1.5×ULN, and ALT≥1.5×ULN, 91.2%, 92.1%, and 94.8%, respectively, had marked (G≥2) liver inflammation and necrosis, which showed a significant difference between the three groups (χ2=28.125, P<0.05); among the three groups of patients, 12.7%, 22.9%, and 24.4%, respectively, had marked (S≥2) liver fibrosis, which showed a significant difference between the three groups (χ2=18.004, P<0.05). Liver inflammatory activity and fibrosis degree aggravated with the increase in the age of CHB patients (χ2=65.768 and 56.056, both P<0.05) and the reduction in serum HBV DNA level (χ2=21.712 and 29.461, both P<0.05). The HBeAg-negative patients had significantly higher liver inflammatory activity and fibrosis stage than the HBeAg-positive patients (χ2=30.798 and 26.380, both P<0.05). Among the HBeAg-positive and HBeAg-negative patients with an age of ≥30 years and 1.5×ULN≤ALT<2×ULN, 100% (40/40) and 97.8% (45/46), respectively, had marked liver inflammation and necrosis. Conclusion Most CHB patients with normal or mildly elevated ALT have marked liver inflammation and varying degrees of liver fibrosis, especially male patients aged ≥30 years. It is recommended to perform liver histopathological examination to assess the indication for antiviral therapy and avoid delay in treatment.
【关键字】:乙型肝炎,慢性; 肝硬化; 病理学,临床
【Key words】:hepatitis B,chronic; liver cirrhosis; pathology,clinical
【引证本文】:JI LX, YANG XX. Liver histological changes and clinical features in chronic hepatitis B with normal or mildly elevated alanine aminotransferase[J]. J Clin Hepatol, 2020, 36(4): 778-782. (in Chinese)
纪林秀, 杨兴祥. ALT水平正常或轻度升高慢性乙型肝炎的肝组织学改变及临床特征分析[J]. 临床肝胆病杂志, 2020, 36(4): 778-782.

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