ALT小于2倍正常值上限的慢性乙型肝炎患者肝组织病理学分析及抗病毒治疗时机探讨  

Antiviral therapy and pathologic analysis of chronic hepatitis B patients with mild elevated alanine transaminase(ALT)

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

机构地区：[1]深圳市第三人民医院,广东深圳518112

出　　处：《中国病毒病杂志》2013年第3期219-223,共5页Chinese Journal of Viral Diseases

基　　金：广东省药学会肝炎用药研究基金资助项目(2012G26)

摘　　要：目的研究丙氨酸氨基转移酶(ALT)<2倍正常值上限(ULN)的慢性乙型肝炎(乙肝)患者肝组织病理及临床特点,探讨ALT为1～2ULN的慢性乙肝抗病毒治疗时机。方法回顾性分析314例慢性乙型肝炎患者不同ALT水平时的肝组织病理情况,其与既往ALT为1～2ULN的相关性以及ALT水平预测肝脏炎症分级为G2以上的灵敏度(SEN)与特异性(SPE)。结果 ALT<30 U/L、<40 U/L、<60U/L、<70U/L、<80U/L及≥80U/L时,肝脏炎症分级为G2以上者分别占1.1%、3.0%、7.1%、7.5%、8.6%及42.0%;纤维化分期为S2以上者分别占53.3%、55.2%、55.0%、54.8%、53.1%及57.9%。肝脏纤维化程度与既往反复ALT为1～2 ULN密切相关。以ALT≥60 U/L(1.5 ULN)、≥80U/L(2ULN)为界时,预测肝脏炎症分级为G2以上的SEN分别为70%、58%,SPE分别为74.2%、84.8%。结论 ALT<2ULN者肝纤维化分期为S2以上者占50%以上。ALT为1～2ULN的慢性乙型肝炎患者,若无法作肝活检或作无创肝纤维化程度评估,ALT≥60U/L(1.5ULN)可作为抗病毒治疗的筛选指标,比ALT≥80U/L(2ULN)为界限更优。Objective To study the pathologic characteristics of chronic hepatitis B （CHB） patients with ala- nine transaminase （ALT） less than 2×ULN （upper limit of normal）. Methods A total of 314 CHB patients were evaluated retrospectively. Liver biopsy was performed to determine the grade of histological inflammation and the stage of liver fibrosis. Results The rates of inflammation grade≥G2 was 1.1%, 3.0%, 7. 1%, 7.5%, 8.6% and 42.0% in patients with ALT levels〈30 U/L,〈40 U/L,〈60 U/L,〈70 U/L,〈80 U/L and ≥80 U/L, respectively. The stage of liver fibrosis ≥S2 was found in over 50% patients with ALT〈2×ULN. There is no significant correlation between the stages of liver fibrosis and the ALT levels. In patients with ALT≥60 U/L （1.5×ULN） and ≥80 U/L （2×ULN）, the sensitivity of identifying the grade of liver inflammation ≥G2 was 70% and 58%, the specificity was 74.2%, 84.8%, respectively. Conclusions There is no significant correlation between the stage of liver fibrosis and low ALT levels （≤2× ULN）. When liver biopsy is not available, ALT≥60U/L （1.5×ULN） can be used as the cut off indicator for antiviral therapy.

关 键 词：丙氨酸氨基转移酶 肝炎 乙型 病理学 

分 类 号：R512.62[医药卫生—内科学]