丙氨酸氨基转移酶持续正常的慢性乙型肝炎病毒感染者的肝脏组织学改变  

Histological changes in the livers of chronic hepatitis B patients with persistently normal serum alanine transaminase levels

作　　者：桂红莲[1] 谢青[1] 王晖[1] 蔡伟[1] 林之莓[1] 姜山[1] 许蓓[1] 周霞秋[1] 郭清[1] 俞红[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025

出　　处：《中华肝脏病杂志》2007年第12期881-885,共5页Chinese Journal of Hepatology

基　　金：上海市科委“登山计划”项目（064119521）

摘　　要：目的探讨ALT水平持续正常的慢性HBV感染者的肝脏组织学的炎症分级和纤维化分期，并分析肝脏组织学改变的相关因素。方法选择2003年10月2007年2月瑞金医院感染科住院经肝活组织检查的139例ALT水平持续正常的慢性HBV感染者。ALT水平持续正常定义为肝活组织检查前至少1年内连续随访3次以上，每次间隔2个月以上，血清ALT均在正常范围、且可检测到HBV的慢性HBV感染者（A组）与同期行肝活组织检查的135例未曾抗病毒治疗过的ALT异常的HBV感染者（B组）进行肝脏组织学特征比较。结果A组中66例（47．5％）患者肝组织正常，但仍有33例（23．7％）肝脏显著组织学改变，有13例（9．4％）患者已发展到肝硬化阶段。与（0～0．75）×正常值上限（ULN）ALT亚组相比，（0．76～1．00）×ULN ALT亚组存在更高比例的肝脏显著组织学改变（43．5％对比19．8％，x^2=5．930，P〈0．05）；与年龄〈40岁者相比，年龄〉40岁的A组患者发生肝脏显著组织学改变者的比例明显增高；无论病毒载量或e抗原状态都不能预测其肝脏显著组织学改变程度。结论无论病毒载量高低、e抗原状态如何，23．7％的持续ALT正常的慢性HBV感染者存在着显著肝脏组织学改变。对可检测到病毒载量的持续ALT正常的慢性HBV感染患者应考虑进行肝脏活检，特别是年龄〉40岁且ALT在（0．76～1．00）×ULN者。Objective To study the histological changes in livers of chronic hepatitis B （CHB） patients with persistently normal serum ALT levels （PNAL）. Methods 274 CHB patients who had percutaneous liver biopsies and had a detectable viral load （lower limit of detection is 10^3 copies/ml） in our department between October 2003 and February 2007 were included in this study. Among these patients, 139 had PNAL, group A, （with at least 3 normal serum ALT levels, with intervals of more than two months over a period of 12 or more months before the biopsy）. The other 135 patients, group B, had abnormal serum ALT levels during the same period. The histological changes in the livers of the two groups of patients were compared. Results Sixty-six （47.5%） patients with PNAL had normal liver histology, but significant pathohistological changes such as significant necroinflammation, fibrosis and/or cirrhosis were found in 33 （23.7%） patients. Thirteen （9.4%） had established cirrhosis. When compared to patients within （0-0.75）× upper limit of normal （ULN） ALT, patients within （0.76-1.00）× ULN ALT had higher scores of histological changes （43.5% vs. 19.8%, P 〈 0.05）. In the PNAL group, scores of histological changes increased sharply in parallel with an age increase of older than 40 yrs. However neither viral loads nor HBeAg statuses of the PNAL patients had any predictive meaning to the scores of the histological findings. Conclusions 23.7% of our CHB patients with PNAL, regardless of what their HBeAg statuses or viral load levels were, had significant liver pathohistological changes. Liver biopsies should be considered in CHB patients with PNAL, especially those older than 40 yrs and with a higher ALT within （0.76-1） × ULN.

关 键 词：肝炎 乙型 慢性 丙氨酸氨基转移酶 组织学 比较 

分 类 号：R686[医药卫生—骨科学]