丙氨酸氨基转移酶轻度升高慢性乙型肝炎患者肝组织病理学改变  

Pathohistological change of he patic biopsies in chronic hepatitis B patients with mild ALT elevation

作　　者：代雪枫[1] 马勇[1] 年磊[1] 

机构地区：[1]解放军第123医院肝病中心,安徽省蚌埠市233015

出　　处：《实用肝脏病杂志》2012年第3期229-231,共3页Journal of Practical Hepatology

摘　　要：目的分析ALT轻度升高的慢性乙型肝炎患者肝组织病理学改变情况,以探讨ALT水平与肝脏炎症及纤维化分期的关系。方法选择216例ALT轻度升高的慢性乙型肝炎患者及83例慢性HBV携带者,进行肝活检,分析肝脏炎症分级(G)及纤维化分期(S)与ALT及年龄的关系。结果在肝炎组中,炎症分级≥G2者占55.6%,明显高于对照组(31.3%);肝炎组纤维化分期≥S2者占62.1%,也明显高于对照组(28.9%,P<0.01),均有显著性差异;在慢性肝炎组中年龄大于40岁者,肝组织炎症分级≥G2及纤维化分期≥S2者分别为69.5%及75.0%,均明显高于年龄<40岁组,差异具有统计学意义(P<0.01);在年龄大于40岁的患者中,ALT>60U/L者G3+4比例(52.9%)高于ALT<60U/L者(31.7%,P<0.05);ALT>60U/L者纤维化分级高(S3+4)者比例也明显高于ALT<60U/L者,差异具有统计学意义(P<0.05),ALT>60U/L组有84.3%纤维化分级≥S2,明显高于ALT<60U/L组(63.4%,P<0.05)。结论部分ALT轻度升高的慢性乙型肝炎患者肝组织病变也处于活动期,其中年龄大于40岁而ALT又大于60U/L者,应开始抗病毒治疗,达不到这个标准的患者应行肝组织活检来决定是否需要抗病毒治疗。Objective To analyze the hepatic pathohistology of biopsies in chronic hepatitis B patients with mild ALT elevation. Methods 216 liver biopsies from patients with chronic hepatitis B with ALT elevation （lower than two times upper limits of normal） and 83 with asymptomatie HbsAg carriers （ASC） were included for liver biopsies. Results 55.6% and 62.1% of patients with CHB had G2 or S2 ,respectively,much higher than those in the ASC group （P〈0.01）; The greater than G2 or S2 in patients with CHB over the age of 40 years were 69.5% or 75.0%,respectively,much higher than in patients younger than 40 years;In patients with chronic hepatitis B and with the age over 40 years,52.9% had G3 to G4 in those with ALT greater than 60u/L,mueh higher than 31.7% in patients with the ALT lower than 60U/L;The fibrosis above S2 staging was 84.3% in patients with ALT greater than 60U/L,much higher than that in patients with ALT lower than 60U/L. Conclusion Part of patients with CHB with mild ALT elevation have liver pathological changes.The patients over the age of 40 years and ALT higher than 60U/L should receive antiviral treatment.

关 键 词：慢性乙型肝炎 丙氨酸氨基转移酶 肝活检 

分 类 号：R512.62[医药卫生—内科学]