ALT正常e抗原阳性慢性HBV感染者肝组织纤维化的影响因素研究  

ALT normal,HBeAg positive chronic hepatitis B and liver fibrosis

作　　者：唐奇远[1] 何清[1] 黄珊[1] 唐蔚[1] 敖飞健[1] 李知玉[1] 张斌[1] 白冰[1] 

机构地区：[1]广东医学院附属深圳市第三人民医院,广东深圳518112

出　　处：《中国病毒病杂志》2012年第3期216-220,共5页Chinese Journal of Viral Diseases

摘　　要：目的探讨丙氨酸氨基转移酶(ALT)持续正常e抗原阳性慢性乙型肝炎病毒(HBV)感染者的肝组织病理特点,研究影响肝组织纤维化程度的相关因素。方法回顾性研究151例ALT正常e抗原阳性慢性HBV感染者的临床病理资料,分别统计其肝组织炎症、肝纤维化程度及免疫组化HBcAg分布的特点;观察肝组织纤维化程度与性别、年龄、血清ALT水平、HBV DNA载量、肝组织炎症,以及免疫组化HBcAg分布的相关性。结果 151例患者中,存在明显肝组织纤维化(≥S2)的占21.2%(32/151)。肝纤维化程度与患者性别、ALT水平无关,与年龄、HBV DNA载量、肝组织炎症、免疫组化HBcAg分布有关。年龄≤30岁(χ2=9.965 2,P<0.05)、HBV DNA载量>107拷贝/ml(χ2=26.675 7,P<0.05)、肝组织炎症G0～1者(χ2=55.509 6,P<0.05),以及免疫组化HBcAg分布为核型者(χ2=47.634 9,P<0.05),其肝纤维化程度较轻微;反之则较重。结论年龄较轻、血清HBV DNA载量较高的患者暂无必要行肝脏病理检查,其肝组织纤维化程度轻微、肝组织炎症及HBcAg分布反映了这类患者尚处于"免疫耐受"状态。Objective To study the characteristics of hepatic pathology of HBeAg positive chronic hepatitis B（CHB） with persistent normal alanine transaminase（ALT）.MethodsPathologic data（grade of histological inflammation,stage of liver fibrosis and distribution type of HBcAg in immunohistochemistry） of 151 CHB patients were collected and analyzed.Results94.7% of CHB patients showed slight liver inflammation（G0-1） but 21.2% had severe liver fibrosis（≥S2）.The positive rate of HBcAg in immunohistochemistry was 89.4%.The stage of liver fibrosis showed no significant correlation with gender and ALT level,but markedly related to age,HBV DNA viral load,liver inflammation and HBcAg distribution type（χ2=9.965 2/26,6 757/55,5 096/47.634 9,P0.05）.Liver fibrosis was minor in patients who were younger than 30 years old,whose viral load were over 107 IU/ml,whom with mild liver inflammation and whose HBcAg was distributed in nucleus.ConclusionsYounger CHB patients with higher viral loads don′t have to perform liver biopsy.Mild liver inflammation and HBcAg nuclear distribution reflect that these patients might be in the＂immune tolerance＂state.

关 键 词：丙氨酸氨基转移酶 E抗原 核心抗原 肝炎 乙型 慢性 病理学 

分 类 号：R512.62[医药卫生—内科学]