慢性乙肝病毒携带者肝脏病理与病毒学指标的相关性分析  

The Relationship between Pathological Feature of Liver Biopsies and Serological Markers of B-hepatitis in Patients with Chronic Asymptomatic Hepatitis B Carrier

作　　者：刘大凤[1] 王林[1] 刘亚玲[1] 陈红[1] 高峰[1] 张鸿[1] 黄勃[1] 

机构地区：[1]四川省成都市传染病医院,四川成都610061

出　　处：《华西医学》2009年第5期1159-1163,共5页West China Medical Journal

基　　金：四川省卫生厅项目(编号070385)

摘　　要：目的:分析慢性乙肝病毒携带者肝组织病理与年龄、病程、血清学及肝脏免疫组化指标的相关性,以确定孰是对病理进程影响最主要的指标。方法:对134例临床诊断的慢性乙肝病毒携带者进行乙肝血清学标志物、肝功能、肝活组织病理及免疫组化的检查。结果:①病理表现为不典型增生者HBeAg阴性组少于HBeAg阳性组,而表现为慢性肝炎者前者多于后者,差异均有显著性;HBV-DNA<105亚组分析两组病理表现无统计学差异;两种病理表现类型在年龄18～40岁组及>40岁组明显多于<18岁,差异均有显著性;两种病理类型在免疫组化双阳性组均多于单阳性组及全阴性组,但无统计学差异。②在炎症(G)及纤维化(S)早期(G0-1和S0-1),HBeAg阳性组多于HBeAg阴性组,HBV-DNA≥105组多于HBV-DNA<105组;而在炎症及纤维化明显期(G2、G3-4和S2、S3-4),结果却相反,但无统计学差异。③相关性分析表明,G及S与患者年龄、病程及乙肝病毒血清学指标有一定的相关性;当分别校正了年龄和病程后,仅S分别与抗-HBs和年龄呈正相关;当同时校正了年龄和病程后,G及S与病毒血清学指标的相关性均消失。④多元逐步回归分析表明,年龄、病程、表面抗原、E抗原、表面抗体和E抗体均是影响G和S的重要因素,而HBV-DNA似乎对G和S无明显影响。结论:①血清HBeAg阳性与否及HBV-DNA滴度高低对肝脏病理进程以及G和S本身无明显影响;但年龄却对肝脏病理进程有影响。②乙肝病毒对肝脏G和S的影响尚取决于患者年龄和病程。③年龄、病程、表面抗原、E抗原、表面抗体和E抗体均是影响G和S的重要因素,而HBV-DNA似乎对G及S无明显影响。Objective： To analyze the relationship among the features of liver, age, hepatitis B carrier duration, serological markers of B-hepatitis and immunohistochemistry in chronic asymptomatic hepatitis B carrier in Sichuan area. Methods.. One hundred and thirty four patients were examined with serological markers of Prhepatitis, liver function, HBV-DNA level, liver biopsy and immunohistochemistry. Results： ①HBeAg^- group was smaller than HBeAg^＋ group in atypical pathological change in liver, but the former was larger than the latter in chronic hepatitis in liver. There was significant statistical difference. HBV-DNA〈10^5 sub-group analysis showed that there was no significant statistical difference between two groups. Atypical pathological change and chronic hepatitis in liver in age from 18 to 40 year group and age〉40 year group were also larger than those in age〈18 year group. There was significant statistical difference. Atypical pathological change and chronic hepatitis in liver in HBsAg^＋ ＋HBcAg^＋ group was more than in HBsAg^＋ ＋HBcAg^- group and HBsAg^-＋HBcAg^- group, but there was no significant statistical difference. ②Early inflammation and fibrosis in liver in HBeAg＋ group was more than that in HBeAg group. That in HBV-DNA≥10^5 group was also larger than one in HBV-DNA〈10^5 group. But terminal in-flammation and fibrosis in HBeAg^＋ group was smaller than in HBeAg^- group and that in HBV-DNA≥105 group was smaller than in HBV-DNA〈10^5 group too. There was significant statistical difference. ③Pearson correlation analyses showed that the inflammation and fibrosis grade in liver was related with age, hepatitis B carrier duration, and serological markers of B- hepatitis. Adjusting for age and hepatitis B carrier duration respectively, partial correlation analyses showed that only fibrosis grade was positive with HBsAb and age respectively. Adjusting for both age and hepatitis B carrier duration, partial correlation analyses showed that there was no relationship between inf

关 键 词：慢性乙肝病毒携带者 病理 免疫组织化学 年龄 病程 多元逐步回归分析 

分 类 号：R512.62[医药卫生—内科学]