ALT正常的HBeAg阳性高病毒载量慢性HBV感染者明显肝组织学改变的独立预测因素

李强; 黄玉仙; 陈良

doi:10.3969/j.issn.1001-5256.2016.07.019

ALT正常的HBeAg阳性高病毒载量慢性HBV感染者明显肝组织学改变的独立预测因素

DOI: 10.3969/j.issn.1001-5256.2016.07.019

复旦大学附属公共卫生临床中心肝炎一科

基金项目:

上海市科委“科技创新行动计划”医学与农业领域重点项目(13401902100)；上海市市级医院新兴前沿技术联合攻关项目(SHDC12015129)；

详细信息

中图分类号: R512.62
计量
- 文章访问数: 1669
- HTML全文浏览量: 25
- PDF下载量: 415
- 被引次数: 0
出版历程
- 出版日期: 2016-07-20

Independent predictive factors for significant liver histological changes in patients with HBe Ag-positive high-viral-load chronic HBV infection and a normal alanine aminotransferase level

Research funding:

摘要

摘要: 目的探索ALT正常的HBe Ag阳性高病毒载量慢性HBV感染者明显肝组织学改变（SLHC）的独立预测因素。方法回顾性分析2013年6月-2015年8月于复旦大学附属公共卫生临床中心住院的116例初治ALT正常的（<50 U/L）HBe Ag阳性高病毒载量（HBV DNA≥105拷贝/ml）慢性HBV感染者临床资料。SLHC定义为炎症≥G2和（或）纤维化≥S2。计量资料组间比较采用t检验或Mann-Whitney U秩和检验,计数资料组间比较采用χ2检验。采用单因素、多因素回归分析筛查SLHC的独立预测因素。结果 116例患者中47例（40.5%）伴SLHC。多因素分析发现年龄、ALT和GGT是ALT正常的HBe Ag阳性高病毒载量慢性HBV感染者伴SLHC的独立预测因素（比值比分别为2.828、1.011、1.089,P值均<0.05）。年龄≤30岁患者SLHC发生率低于年龄>30岁患者（21.6%vs 49.4%,χ2=6.42,P=0.015）;ALT≤30 U/L患者SLHC发生率低于30 U/L
- 肝炎病毒,乙型 /
- 肝炎e抗原,乙型 /
- 丙氨酸转氨酶 /
- 病毒载量 /
- 危险因素
Abstract: Objective To investigate the independent predictive factors for significant liver histological changes( SLHCs) in patients with HBe Ag- positive high- viral- load chronic hepatitis B virus( HBV) infection and a normal alanine aminotransferase( ALT) level. Methods A retrospective analysis was performed on the clinical data of 116 previously untreated patients with HBe Ag- positive high- viral-load( HBV DNA≥105copies / ml) chronic HBV infection and a normal ALT level( < 50 U/L) who were hospitalized in Shanghai Public Health Clinical Center Affiliated to Fudan University from June 2013 to August 2015. The definition of SLHCs was inflammation ≥G2 and /or fibrosis≥S2. The t- test or Mann- Whitney U rank sum test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Univariate and multivariate regression analyses were used to determine independent predictive factors for SLHCs. Results Of all the 116 patients,47( 40. 5%) had SLHCs. The multivariate analysis showed that age( OR = 2. 828,P < 0. 05),ALT( OR = 1. 011,P < 0. 05),and gamma- glutamyl transpeptidase( GGT)( OR = 1. 089,P< 0. 05) were independent predictors for SLHCs in patients with HBe Ag- positive high- viral- load chronic HBV infection and a normal ALT level. The patients aged ≤30 years had a significantly lower incidence rate of SLHCs than those aged > 30 years( 21. 6% vs 49. 4%,χ2= 6. 42,P = 0. 015),the patients with ALT ≤30 U/L had a significantly lower incidence rate of SLHCs than those with 30 U/L < ALT≤50 U/L( 17. 6% vs 50. 0%,χ2= 19. 86,P < 0. 001),and the patients with GGT≤40 U/L had a significantly lower incidence rate of SLHCs than those with GGT > 40 U/L( 28. 8% vs 66. 7%,χ2= 28. 63,P < 0. 001). Conclusion In patients with HBe Ag- positive high-viral- load chronic HBV infection and a normal ALT level,those with an age of > 30 years,ALT > 30 U/L,and GGT > 40 U/L tend to develop SLHCs and need liver biopsy.
- hepatitis B virus /
- hepatitis B e antigens /
- alanine transaminase /
- viral load /
- risk factors

HTML全文

参考文献(16)

[1]RAPTOPOULOU M,PAPATHEODORIDIS G,ANTONIOU A,et al.Epidemiology,course and disease burden of chronic hepatitis Bvirus infection.HEPNET study for chronic hepatitis B:a multicentre Greek study[J].J Viral Hepat,2009,16(3):195-202.

[2]LIANG P,ZU J,YIN J,et al.The independent impact of newborn hepatitis B vaccination on reducing HBV prevalence in China,1992-2006:a mathematical model analysis[J].J Theor Biol,2015,386:115-121.

[3]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.

[4]LI J,LIU ZQ,LU YF,et al.Analysis of correlations of age with liver pathological change and HBV DNA level in chronic HBV infection patients with normal ALT and mild ALT elevation[J].J Clin Hepatol,2015,31(4):537-540.(in Chinese)李静,刘志权,路毓峰,等.ALT正常和轻度升高慢性HBV感染者的年龄与肝组织病理HBV DNA定量的相关分析[J].临床肝胆病杂志,2015,31(4):537-540.

[5]ZHANG N,ZHAO YY,OU WN,et al.Analysis on the liver histology of 229 chronic hepatitis B patients with normal or slightly elevated alanine aminotransferase level[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition,2014,8(1):17-21.(in Chinese)张娜,赵莹莹,欧蔚妮,等.肝功能正常或轻度异常的慢性HBV感染者肝组织病理改变分析[J/CD].中华实验和临床感染病杂志:电子版,2014,8(1):17-21.

[6]LIAW YF,KAO JH,PIRATVISUTH T,et al.Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2012 update[J].Hepatol Int,2012,6(3):531-561.

[7]MARTIN P,LAU DT,NGUYEN MH,et al.A treatment algorithm for the management of chronic hepatitis B virus infection in the United States:2015 update[J].Clin Gastroenterol Hepatol,2015,13(12):2071-2087.

[8]Chinese Society of Infectious Diseases and Parasitology Disease,Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Hepatol,2000,8(6):324-329.(in Chinese)中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.

[9]GUI HL,WANG H,YANG YH,et al.Significant histopathology in Chinese chronic hepatitis B patients with persistently high-normal alanine aminotransferase[J].J Viral Hepat,2010,17(Supp1):44-50.

[10]KUMAR M,SARIN SK,HISSAR S,et al.Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT[J].Gastroenterology,2008,134(5):1376-1384.

[11]MYERS RP,TAINTURIER MH,RATZIU V,et al.Prediction o liver histological lesions with biochemical markers in patients with chronic hepatitis B[J].J Hepatol,2003,39(2):222-230.

[12]LEMOINE M,SHIMAKAWA Y,NAYAGAM S,et al.The gammaglutamyl transpeptidase to platelet ratio(GPR)predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa[J].Gut,2015.pii:gutjnl-2015-309260.

[13]BENINI F,PIGOZZI MG,BAISINI O,et al.Increased serum gamma-glutamyl-transpeptidase concentration is associated with nonalcoholic steatosis and not with cholestasis in patients with chronic hepatitis C[J].J Gastroenterol Hepatol,2007,22(10):1621-1626.

[14]HAK.The serum gamma glutamyl transpeptidase-A non invasive diagnostic bio marker of chronic anicteric non alcoholic liver diseases[J].J Clin Diagn Res,2013,7(4):691-694.

[15]TERRAULT NA,BZOWEJ NH,CHANG KM,et al.AASLDguidelines for treatment of chronic hepatitis B[J].Hepatology,2016,63(1):261-283.

[16]SARIN SK,KUMAR M,LAU GK,et al.Asian-Pacific clinical practice guidelines on the management of hepatitis B:a 2015 update[J].Hepatol Int,2016,10(1):1-98.

施引文献

资源附件(0)

访问统计