慢性无症状乙型肝炎病毒携带者肝组织病理及临床分析  

Pathological and clinical analysis of chronic asymptomatic HBV carriers

作　　者：朱陇东[1] 袁宏[1] 陈琳[1] 

机构地区：[1]兰州大学第一医院感染科,兰州730000

出　　处：《临床肝胆病杂志》2010年第6期633-634,637,共3页Journal of Clinical Hepatology

摘　　要：目的探讨慢性无症状乙型肝炎病毒携带者(ASC)肝组织病理特点及与血清HBV DNA、HbeAg、Hbe-Ab之间的相关性。方法对56例ASC进行肝组织活检病理检查及血清HBV DNA、HBV-maker定量测定。结果 71%(40/56)发生程度不等炎症病理改变,大部分为轻度改变,28%(16/56)发生程度不等纤维化病理改变,大部分病理诊断为轻度,极少部分为中度和重度,3%(2/56)达G3以上。ASC中血清HBV DNA复制水平与肝脏病理炎症及纤维化程度无相关性。HbeAg阴性组肝脏炎症和纤维化程度显著高于阳性组。结论 ASC患者中大部分存在轻度炎症改变,个别患者出现程度较重的纤维化改变或早期肝硬化病理改变,HbeAg阴性的ASC病理改变较HbeAg阳性者严重,并且肝脏病理与血清HBV DNA载量之间并无相关性,所以对这些患者仅仅定期检测肝功能及病毒载量,可能会掩盖部分患者病情进展,所以尽可能应对ASC及早行肝活检,及时判断肝脏炎症和纤维化程度并指导抗病毒治疗,这是其他检查不能替代的。Objective To study the pathological features of liver and its relation with serum levels of HBV DNA,HbeAg,HbeAb in chronic asymptomatic HBV carriers（ASC）.Methods Pathological analysis of liver biopsies,serum HBV DNA and HBV-Marker levels were measured in 56 ASC.Results Different degrees of inflammation were seen in 71%（40/56） of the patients of which most of them were minor changes.Varying degrees fibrosis changes were seen in 28%（16/56） of which most were mild and minimal part of the cases were moderately severe;especially 3%（2 /56） of the patients were more than G3.There was no correlation between levels of HBV DNA,levels of liver inflammation and fibrosis.The levels of liver inflammation and fibrosis in HbeAg negative groups were higher than HbeAg positive group.Conclusion Severe fibrosis or early cirrhosis of the liver pathological change is observed in minor cases especially in HbeAg negative ASC.There is no correlation between levels of HBV DNA replication and levels of liver inflammation and fibrosis.Regular liver function tests and viral load only may not find out disease progression in these patients.Therefore,early liver biopsy could be used to determine the degrees of liver inflammation and fibrosis and guide the anti-viral treatment.

关 键 词：肝炎 乙型 带病原状态 活组织检查 

分 类 号：R512.62[医药卫生—内科学]