首 页   本刊简介  编委会  审稿专家  在线期刊  写作规范  广告合作  联系我们
您现在的位置:首页 => 在线期刊 => 2019年 5期 “胰腺癌多学科综合诊疗”重点号 => 病毒性肝炎 =>HBV DNA低水平..
HBV DNA低水平患者肝组织炎症活动度和纤维化程度的影响因素分析
Influencing factors for liver inflammation grade and fibrosis degree in patients with low-level HBV DNA
文章发布日期:2019年04月04日  来源:  作者:刘立,李俊义,杜映荣,等  点击次数:358次  下载次数:70次

调整字体大小:

(此处下载失败可以在在线预览处保存副本或者右键另存为)

【摘要】:目的分析HBV DNA低水平患者肝组织病理特征及相关因素,为HBV DNA低水平患者的病情判断提供依据。方法选取2014年1月-2017年12月于云南省昆明市第三人民医院就诊的HBV DNA>20 IU/ml且<2000 IU/ml者137例,对患者肝组织行病理检查,炎症分级:G1 44例,G2 84例,G3 9例;纤维化分期:S0 2例,S1 67例,S2 56例,S3 9例,S4 3例。分析患者肝组织炎症和纤维化程度与年龄、性别、感染HBV时间、血生化、HBsAg水平、HBV DNA等的关系。计量资料多组间比较采用Kruskal Wallis H检验,计数资料组间比较采用χ2检验,使用单因素和多因素单向非条件logistic回归分析肝组织病理炎症活动≥G2和纤维化程度≥S2的影响因素。结果G1、G2、G3 3组间HBsAg、PLT、脾静脉内径和脾脏厚度比较,差异均有统计学意义(H值分别为7.135、7.458、7.588、10.150,P值均<0.05);S0、S1、S2、S3、S4 5组间HBsAg、PLT、门静脉内径、脾静脉内径和脾脏厚度比较,差异均有统计学意义(H值分别为20.564、12.065、26.171、14.720、13.725,P值均<0.05)。137例患者无或轻度炎症坏死44例(<G2组),中重度炎症坏死93例(≥G2组),将单因素logistic回归分析有意义的年龄、ALT、ALP、WBC、脾静脉内径和脾脏厚度(检验水平调为0.15)纳入多因素分析显示年龄[比值比(OR)=1.045)]、ALP(OR=1.019)和脾脏厚度(OR=1150)是低水平HBV DNA者肝组织炎症≥G2的独立危险因素(P值均<0.05)。137例患者无或轻度肝纤维化69例(<S2组),中重度肝纤维化68(≥S2组),将单因素logistic回归分析有意义的TBil、HBsAg、PLT和门静脉内径(检验水平调为0.15)纳入多因素分析显示HBsAg(OR=2.065)、PLT(OR=0.988)和门静脉宽度(OR=2.464)是低水平HBV DNA者肝组织纤维化≥S2的独立影响因素。结论绝大多数HBV DNA低水平患者均有抗病毒治疗指征,年龄、ALP和脾脏厚度与低水平HBV DNA者肝组织炎症程度密切相关;HBsAg、PLT和门静脉宽度与低水平HBV DNA者肝组织纤维化程度密切相关。
【Abstract】:ObjectiveTo investigate liver pathological features and related factors in patients with low-level HBV DNA, and to provide a basis for evaluating the conditions of such patients. MethodsA total of 137 patients with an HBV DNA level of <2000 IU/ml and >20 IU/ml who attended The Third People′s Hospital of Kunming from January 2014 to December 2017 were enrolled. Liver pathological examination was performed for all patients. Of all patients, 44 had grade 1 (G1) liver inflammation, 84 had grade 2 (G2) liver inflammation, and 9 had grade 3 (G3) liver inflammation; as for fibrosis stage, 2 had S0 fibrosis, 67 had S1 fibrosis, 56 had S2 fibrosis, 9 had S3 fibrosis, and 3 had S4 fibrosis. The correlation of liver inflammation grade and fibrosis stage with age, sex, duration of HBV infection, blood biochemistry, HBsAg level, and HBV DNA was analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and univariate and multivariate one-way non-conditional logistic regression analyses were used to investigate the influencing factors for ≥G2 liver inflammation and ≥S2 fibrosis. ResultsThere were significant differences in HBsAg, platelet count (PLT), diameter of the splenic vein, and spleen thickness between the G1, G2, and G3 groups (H=7.135, 7.458, 7.588, and 10.150, all P<0.05), and there were also significant differences in HBsAg, PLT, diameter of the portal vein, diameter of the splenic vein, and spleen thickness between the S0, S1, S2, S3, and S4 groups (H=20.564, 12.065, 26.171, 14.720, and 13.725, all P<0.05). Of all 137 patients, 44 had no or mild inflammation and necrosis (<G2 group) and 93 had moderate or severe inflammation and necrosis (≥G2 group); age, alanine aminotransferase, alkaline phosphatase (ALP), white blood cell count, diameter of the splenic vein, and spleen thickness, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis (α=0.15), and the results showed that age (odds ratio [OR]=1045, P<0.05), ALP(OR=1.019, P<0.05), and spleen thickness (OR=1.150, P<0.05) were independent risk factors for ≥G2 liver inflammation in the patients with low-level HBV DNA. Of all 137 patients, 69 had no or mild liver fibrosis (<S2 group) and 68 had moderate or severe liver fibrosis (≥S2 group); total bilirubin, HBsAg, PLT, and diameter of the portal vein, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis (α=0.15), and the results showed that HBsAg (OR=2.065), PLT(OR=0.988), and diameter of the portal vein (OR=2.464) were independent risk factors for ≥S2 liver fibrosis in the patients with low-level HBV DNA. ConclusionThe majority of patients with low-level HBV DNA have the indication of antiviral therapy. Age, ALP, and spleen thickness are closely associated with liver inflammation grade in patients with low-level HBV DNA, and HBsAg, PLT, and diameter of the portal vein are closely associated with liver fibrosis.
【关键字】:乙型肝炎病毒; 病毒载量; 炎症; 病理学, 临床; 危险因素
【Key words】:hepatitis B virus; viral load; inflammation; pathology, clinical; risk factors
【引证本文】:LIU L, LI JY, DU YR, et al. Influencing factors for liver inflammation grade and fibrosis degree in patients with low-level HBV DNA[J]. J Clin Hepatol, 2019, 35(5): 982-986. (in Chinese)
刘立, 李俊义, 杜映荣, 等. HBV DNA低水平患者肝组织炎症活动度和纤维化程度的影响因素分析[J]. 临床肝胆病杂志, 2019, 35(5): 982-986.

地址:长春市东民主大街519号《临床肝胆病杂志》编辑部 邮编:130061 电话:0431-88782542/3542
临床肝胆病杂志 版权所有 Copyright © 2009 - 2013 Lcgdbzz.org. All Rights Reserv 吉ICP备10000617号

吉公网安备 22010402000041号