HBeAg阴性慢性乙型肝炎病毒感染者肝组织病理改变的相关因素分析  

Analysis of the factors related to the changes of liver pathology in HBeAg negative chronic hepatitis B patients

作　　者：朱雄鹰[1] 骆欣[1] 余吉仙[1] 陈公英[1] 

机构地区：[1]杭州市第六人民医院9病区,310014

出　　处：《中华传染病杂志》2008年第6期362-366,共5页Chinese Journal of Infectious Diseases

摘　　要：目的分析HBeAg阴性慢性HBV感染者肝组织病理改变的相关因素。方法对288例不同年龄、性别、ALT水平、肝组织HBsAg和HBcAg免疫组织化学结果的HBeAg阴性HBV感染者的HBV DNA载量、肝组织病理变化进行相关分析，采用Bivariate Pearson法。结果男性组肝组织炎症分级和纤维化分期分别为1．72±1.23和1.71±1.24，女性组分别为1.25±1.39和1．21±1.40，两组差异有统计学意义（t=2．398，t=2．551；均P〈0．05）；男性HBV DNA载量高于女性，但差异无统计学意义。40岁以上HBeAg阴性HBV感染者HBVDNA载量、肝组织炎症分级和纤维化分期显著高于40岁以下者（t=2．060，t=2．536，t=2．808；均P〈0．05）。ALT正常的HBeAg阴性乙型肝炎患者中，75例（52．03％）血清HBVDNA≤1×10^3拷贝／mL，肝组织炎症活动度≥G2的56例，占38．89％，血清ALT水平与肝组织炎症活动度相关（r=0．244，P=0．004）。ALT异常的慢性HBV感染者中，42例（31.57％）血清HBV DNA≤1×10^3拷贝／mL，肝组织炎症活动度≥G2的89例，占66．92％。血清ALT水平与肝组织炎症程度无相关（r=0．007，P=0．939）。肝组织免疫组织化学HBsAg及HBcAg双阳性组肝组织炎症／纤维化、HBVDNA滴度显著高于HBsAg、HBcAg双阴性组和HBsAg阳性、HBcAg阴性组，差异有统计学意义。血清HBV DNA与肝组织炎症程度相关（r=0．349，P〈0．05）。结论性别、年龄、血清HBV DNA水平及HBsAg、HBcAg免疫组织化学结果可作为判断HBeAg阴性慢性乙型肝炎患者肝组织炎症损伤程度的相关指标，男性、年龄越大、血清HBV DNA水平越高、肝组织免疫组织化学HBsAg及HBcAg双阳性，肝组织炎性反应损伤越严重。HBeAg阴性慢性乙型肝炎患者即使ALT正常、血清HBVDNA≤1×10^3拷贝／mL，仍约1／3患者的肝组织存在明显的炎性反应损伤，需定期追踪，最好行肝组织活检，以早期发现适宜治疗者而避免延误病情。Objective To analyze the factors related to the changes of liver pathology in hepatitis B e antigen （HBeAg） negative chronic hepatitis B （CHB） patients. Methods Two hundred and eighty-eight HBeAg negative CHB patients were enrolled. Bivariate Pearson correlation was employed to analyze the correlation of different age, gender, alanine aminotransferase （ALT） level, the immunohistochemistry results of hepatitis B surface antigen （HBsAg） and hepatitis B core antigen （HBcAg） in liver tissue with hepatitis B virus （HBV） DNA level, changes of liver pathology. Results The inflammation grades and fibrosis stages of liver tissues in male were 1. 72±1. 23 and 1. 71±1. 24, respectively; 1. 25±1.39 and 1. 21±1. 40 in female, respectively, which were significantly different （t = 2. 398, t= 2. 551; both P〈0.05）. The HBV DNA levels in male were higher than those in female, but not significantly. The HBV DNA levels, inflammation grades and fibrosis stages of liver tissues in patients 〉 40 years old were all significantly higher than those 〈 40 years old （t=2. 060,t=2. 536,t=2. 808; all P〈0.05）. In patients with normal ALT levels, 75 cases （52.03%） showed HBV DNA level ≤1 ×10^3 copy/mL, 56（38.89%） showed ≥G2 of liver tissues; the ALT level and inflammation grade of liver tissues was significantly correlated （r=0. 244, P=0. 004）. In patients with elevated ALT levels, 42 cases （31. 57%） showed HBV DNA level≤ 1 ×10^3 copy/mL, 89 （66.92%） showed ≥G2 of liver tissues; the ALT level and inflammation grade of liver tissues was not significantly correlated （r=0. 007, P= 0. 939 ）. The inflammation/fibrosis of liver tissues, HBV DNA levels in patients with both HBsAg and HBcAg positive in liver tissues were significantly higher than those in other patients （P〈0.05）. There was significant relationship between serum HBV DNA level and inflammation grade of liver tissue（r=0. 349,P〈0.05）. Conclusions Gender, age, serum HBV DNA level and expressions of HBsA

关 键 词：肝炎 乙型 慢性 肝炎e抗原 乙型 DNA 病毒 活组织检查 

分 类 号：R51[医药卫生—内科学]