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ALT水平正常的慢性乙型肝炎患者的血清学特征及肝组织病理学分析

刘珊珊 陆忠华

引用本文:
Citation:

ALT水平正常的慢性乙型肝炎患者的血清学特征及肝组织病理学分析

DOI: 10.12449/JCH240512
基金项目: 

无锡市医学重点学科建设项目-创新团队 (CXTD2021009);

太湖人才计划 (20200803)

伦理学声明: 本研究方案于2023年7月18日经由无锡第五人民医院伦理委员会审批,批号:2023-008-1。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:刘珊珊负责数据收集,统计数据,撰写论文;陆忠华负责设计论文框架,修改文章并最后定稿。
详细信息
    通信作者:

    陆忠华, lu_z_h@126.com (ORCID: 0000-0002-5388-8301)

Serological features and liver histopathology of chronic hepatitis B patients with normal alanine aminotransferase

Research funding: 

Wuxi Medical Key Discipline Construction Project-Innovation Team (CXTD2021009);

Taihu Talent Program (20200803)

More Information
    Corresponding author: LU Zhonghua, lu_z_h@126.com (ORCID: 0000-0002-5388-8301)
  • 摘要:   目的  分析ALT水平正常的慢性乙型肝炎(CHB)患者的肝组织病理学特点及与血清学指标间的关系。  方法  收集2018年4月—2021年6月无锡市第五人民医院137例ALT水平正常CHB患者的临床资料,分析肝组织病理与血清学指标间的差异及相关性。计数资料组间比较采用χ2检验。采用Speraman秩相关进行相关性分析。采用Logistic回归进行多因素分析。  结果  ALT水平<20 U/L、20~29 U/L、30~40 U/L患者中分别有57.4%、53.4%、75%具有显著炎症坏死(≥G2),63.8%、62.1%、75%具有显著纤维化(≥S2)。HBeAg阳性/阴性、不同水平的血清HBV DNA、不同水平的血清HBV RNA在炎症活动程度分级上差异均有统计学意义(χ2值分别为10.008、6.911、7.946,P值均<0.05);HBeAg阳性/阴性、不同水平的血清HBV RNA在纤维化分期上差异均有统计学意义(χ2值分别为7.996、10.874,P值均<0.05)。肝脏炎症程度及纤维化分期与血清HBV DNA无明显相关性(rs=0.024,P=0.785;rs=0.039,P=0.652),与血清HBV RNA存在显著相关性(rs=0.222,P=0.009;rs=0.187,P=0.029)。多因素分析提示HBeAg阳性是CHB患者肝脏发生炎症坏死(OR=-0.302,95%CI:-1.160~0.386,P=0.002)及纤维化(OR=-0.387,95%CI:-1.160~0.386,P=0.011)的独立危险因素。  结论  ALT水平正常的CHB患者的肝脏组织存在不同程度的显著炎症坏死及纤维化,HBeAg阳性是这类患者肝脏组织出现显著炎症坏死及纤维化的独立危险因素。

     

  • 表  1  肝组织病理学炎症活动程度分级、纤维化分期情况

    Table  1.   The result of liver Liver histopathology inflammation grading, fibrosis staging

    炎症活动程度分级 例(%) 纤维化分期 例(%)
    G0~1 55(40.1) S0~1 47(34.3)
    G2 69(50.4) S2 47(34.3)
    G3 13(9.5) S3 22(16.1)
    G4 0(0.0) S4 21(15.3)
    下载: 导出CSV

    表  2  临床资料与炎症活动程度分级、纤维化分期的关系

    Table  2.   Relationship of clinical data to inflammation grading and fibrosis staging

    因素 例数 炎症活动程度分级 χ2 P 肝纤维化分期 χ2 P
    G0~G1 G2 G3~G4 S0~S1 S2 S3~4
    年龄 1.814 0.404 0.711 0.701
    <30岁 8 4 4 0 2 4 2
    30~39岁 38 17 19 2 13 17 8
    ≥40岁 91 34 46 11 32 26 33
    ALT 4.858 0.088 4.755 0.093
    <20 U/L 47 20 23 4 17 22 8
    20~29 U/L 58 27 27 4 22 16 20
    30~40 U/L 32 8 19 5 8 9 15
    血清HBeAg 10.008 0.040 7.996 0.046
    阳性 28 8 12 8 10 6 12
    阴性 109 47 57 5 37 41 31
    血清HBV DNA 6.911 0.032 5.910 0.050
    <104 IU/mL 96 44 44 8 37 32 27
    104~<107 IU/mL 22 3 16 3 2 17 3
    ≥107 IU/mL 19 8 9 2 8 6 5
    血清HBV RNA 7.946 0.019 10.874 0.012
    <104拷贝/mL 96 45 45 6 39 34 23
    ≥104拷贝/mL 41 10 24 7 8 13 20
    下载: 导出CSV
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  • 收稿日期:  2023-08-04
  • 录用日期:  2023-10-07
  • 出版日期:  2024-05-25
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