丙氨酸氨基转移酶低于2倍正常值的慢性乙肝患者肝组织学的改变  

Change of liver histology in chronic hepatitis B patients with alanine aminotransferase less than two-time up limits of normal

作　　者：陈恩强[1] 何伶俐[1] 王丽春[1] 雷秉钧[1] 白浪[1] 刘聪[1] 雷学忠[1] 唐红[1] 

机构地区：[1]四川大学华西医院感染疾病中心,生物治疗国家重点实验室(四川大学)感染性疾病研究室,四川省成都市610041

出　　处：《世界华人消化杂志》2008年第22期2476-2481,共6页World Chinese Journal of Digestology

基　　金：国家重点基础研究计划(973)资助项目;No.2007CB512902;No.2006CB504302~~

摘　　要：目的:分析丙氨酸氨基转移酶低于2倍正常值上限(upper limits of normal,ULN)的慢性乙肝患者肝组织学改变情况,并探讨影响肝脏组织学改变的因素.方法:根据ALT≤0.5×ULN、0.5×ULN<ALT≤1×ULN和1×ULN<ALT<2×ULN将170患者分成Ⅰ(n=39)、Ⅱ(n=87)、Ⅲ组(n=44),对肝组织学改变是否同ALT水平、HBeAg状态、HBV DNA复制水平及年龄存在相关性进行回顾性分析.结果:共纳入170例患者,Ⅰ、Ⅱ、Ⅲ组炎症活动度为G2及G2以上者分别为43.6%、56.4%和65.9%;纤维化分期为S2及S2以上者分别为38.4%、48.3%和61.3%,三组中分别有5.1%、8.1%和18.2%的患者组织学表现为肝硬化(S4).炎症活动度及纤维化程度与ALT均有关(F=4.162,3.992,均P<0.05),炎症活动度及纤维化程度与年龄有关(F=32.831,20.084,均P<0.05),纤维化程度与HBeAg阳性率有关(χ2=7.839,P<0.05).结论:慢性HBV感染者即使ALT<2×ULN,也有55.9%的患者肝组织炎症活动度在G2或G2以上,因此对于病史较长,特别是年龄在40岁以上的患者建议常规进行肝组织活检,根据肝组织活检病理结果决定是否对其进行抗病毒治疗.AIM： To analyze the change of hepatic histology in patients with chronic infection whose alanine hepatitis B virus （HBV） aminotransferase （ALT） level is lower than two-time up limit of normal （ULN） and discuss the factors affecting the change of liver histology METHODS： According to ALT ≤ 0,5 × ULN, 0.5 × ULN 〈 ALT ≤ 1 ×ULN and 1 × ULN 〈 ALT 〈 2 × ULN, 170 patients were divided into group Ⅰ （n = 39）, group Ⅱ （n = 87） and group Ⅲ （n = 44）. We retrospectively analyzed whether the change of liver histology was related to ALT level, HbeAg status, HBV DNA duplication and the age of patients. RESULTS： The rates of grade 2 or 2＋ inflammation in group Ⅰ, Ⅱ and Ⅲ were 43.6%, 56.4% and 65.9%, respectively, and the rates of stage 2 or 2＋ fibrosis were 38.4%, 48.3% and 61.3%, respectively. There were 5.1%, 8.1% and 18.2% patients with liver cirrhosis （stage 4） in the three groups. The activity of liver inflammation and degree of fibrosis were related to ALT level （F = 4.162, 3.992; both P 〈 0.05） and the age of patients （F = 32.831, 20.084; both P 〈 0.05）, while the degree of liver fibrosis was related with HbeAg positive rate （x^2 = 7.839, P 〈 0.05）. CONCLUSION： Of the patients with chronic HBV infection, 55.9% have grade 2 or 2＋ inflammation even if ALT level is less than 2 × ULN. Thus for the patient with a long medical history, especially those over 40 years old, conventional liver biopsy should be performed, which may help us decide whether to start antiviral therapy.

关 键 词：慢性乙型肝炎 丙氨酸氨基转移酶 组织学 肝活检 

分 类 号：R512.62[医药卫生—内科学]