“免疫耐受期”慢性乙型肝炎病毒感染者临床与肝脏病理学特点  

Clinical and pathological characteristics of patients with chronic hepatitis B virus infection in immune tolerant phase

作　　者：李嘉[1] 赵桂鸣[1] 李颖[1] 邹怀宾[1] 刘均娟[1] 朱理珉[1] 梁树人[1] 

机构地区：[1]天津市传染病医院天津市肝病研究所,300192

出　　处：《中华传染病杂志》2008年第11期662-665,共4页Chinese Journal of Infectious Diseases

摘　　要：目的了解免疫耐受期慢性HBV感染者临床及肝脏病理学特征。方法分析98例“免疫耐受期”慢性HBV患者年龄、性别、血清HBV DAN水平、肝脏炎症活动度及纤维化程度、肝脏HBsAg和HBcAg表达情况。并对不同血清ALT水平的肝脏炎症活动度及纤维化程度进行比较。采用x^2检验。结果98例患者中，〈30岁者83例，占84．7％，≥30岁者15例，占15．3%。有48．0％感染者的母亲HBsAg阳性。所有感染者血清HBV DNA为高水平复制，〉1×10^7拷贝／mL者占78．5％。仅5例感染者肝脏炎症活动度为G0，占5．1％；其中G164例，占65．3％；G229例，占29．6％。56例肝脏无明显纤维化（S0），占57．1％；S123例，占23．5％；S214例，占14．3％；S35例，占5．1％；未发现肝硬化。肝组织HBsAg阳性79例，占80．6％；HBcAg阳性80例，占81．6％。血清ALT在正常范围高水平的感染者肝脏纤维化程度明显高于ALT低水平者（x^2=8．1123，P=0．0437）。结论绝大部分“免疫耐受期”慢性HBV感染者肝脏存在轻度炎性反应，部分已出现纤维化；对“免疫耐受期”HBV感染者进行肝脏病理学检查，有利于正确判断病情和确定治疗方案。Objective To investigate the clinical and pathological characteristics of patients with chronic hepatitis B virus （HBV） infection in immune tolerant phase. Methods Ninety-eight chronic HBV carriers in immune tolerant phase were enrolled in this study. The age, gender, serum HBV DNA level, hepatic inflammatory activity and fibrosis, hepatic HBsAg and HBcAg expressions were analyzed. The grade of inflammatory activity and stage of fibrosis were also compared in patients with different levels of serum alanine aminotransferase （ALT）. Data analysis was done by chi square test. Results In 98 patients, 83 （84.7%） were〈30 years old and 15 （15.3%） were≥30. Patients whose mother was HBsAg positive were 48.0%. High levels of serum HBV DNA were found in all patients, with 78.5% were〉 1 × 10^7 copy/mL. Only 5 cases （5.1%） were GO of the inflammatory grade; whereas, 64 cases （65.3%） were G1, 29 （29.6%） were G2. There were 56 patients （57.1%） had no significant liver fibrosis; and 23 cases （23.5%） were S1, 14（14.3%）were S2, 5（5.1%）were S3; none of patients had cirrhosis. The HBsAg and HBcAg in liver tissues were positive in 79 （80.6%） and 80 （81.6%） cases, respectively. The fibrosis stages of patients with higher ALT levels were significantly greater than patients with lower ALT levels （x^2 = 8. 112 3, P= 0. 043 7）. Conclusions Most of patients with chronic HBV infection in immune tolerant phase present mild inflammation in liver, some of them have already developed fibrosis. Therefore, liver pathology is recommended for these patients to help understand the patients＇ conditions and make correct therapeutic decisions.

关 键 词：肝炎 乙型 慢性 DNA病毒 肝硬化 肝炎表面抗原 乙型 肝炎核心抗原 乙型 

分 类 号：R512.62[医药卫生—内科学]