253例低丙氨酸氨基转移酶乙型肝炎病毒感染者临床生化和肝组织病理学分析  

Liver histopathological and biochemical features in 253 hepatitis B virus infected patients with low serum amino- transferase levels

作　　者：李芳[1] 叶珺[1] 郜玉峰[1] 魏艳艳[1] 夏国美[1] 金蕾[1] 邹桂舟[1] 

机构地区：[1]安徽医科大学第二附属医院肝病科,合肥市230601

出　　处：《实用肝脏病杂志》2013年第5期427-429,共3页Journal of Practical Hepatology

摘　　要：目的观察在低丙氨酸氨基转移酶(ALT)水平(<2×ULN)的慢性HBV感染者中,不同ALT水平感染者临床生化指标和肝脏组织病理学分级的差异。方法根据ALT水平不同,将253例ALT小于2倍ULN患者分为三组,A组为男性ALT≤30U/L和女性ALT≤19U/L(n=74),B组为男性30U/L<ALT≤60U/L和女性19U/L<ALT≤38U/L(n=119),和C组为男性60U/L<ALT≤80U/L和女性38U/L<ALT≤80U/L(n=60)。观察各组人群血生化指标和肝脏炎症分级(G)和纤维化分期(S)的差异。结果本组A组、B组和C组患者HBeAg阳性率分别为39.2%、47.1%和71.7%(x2=15.1,P<0.01);三组患者年龄分别为39.5±11.9岁、34.5±11.4岁和31.6±11.6岁(F=8.1,P=000);A组血清AST、GGT和AST/血小板比值(APRI)分别为22.9±6.6u/L、31.6±22.9u/L和0.2±0.1,B组分别为36.5±26.7u/L、39.9±30.8u/L和0.3±0.2,C组分别为44.3±11.6u/L、47.3±49.3u/L和0.4±0.3,三组相差显著(P<0.05);A组肝组织G2为16.2%,明显低于B组(35.3%)和C组(30.0%,P<0.05);3组肝组织肝纤维化程度无显著性相差(P>0.05)。结论在ALT<2倍ULN的HBV感染者中,不同ALT水平者血生化指标和肝组织炎症程度存在差异,需要区别处理。Objective To evaluate the liver histopathological and biochemical features in 253 hepatitis B virus infected patients with low serum aminotransferase levels. Methods Two hundred and fifty-three HBV-infected patients with serum ALT less than 2xULN were divided into three groups according to ALT levels： i.e.,in group A with serum ALT≤30U/L for male and ALT≤19U/L for female,in group B with 30U/L〈ALT≤60U/L for male and 19U/L〈ALT≤38U/L for female,and in group C with 60U/L〈ALT±80U/L for male and 38U/L〈ALT≤ 80U/L for female. Blood parameters and the grades of liver inflammation and stages of liver fibrosis were deter- mined. Results The serum HBeAg positive rates in group A,B and C were 39.2%,47.1% and 71.7%,respectively（x2=15.1,P〈0.01 ） ; The patients＇ age were 39.5±11.9,34.5±11.4 and 31.6±11.6 year-old, respectively（F= 8.1,P=000）;The serum AST,GGT and the ratio of AST/ platelet （APRI）in group A were 22.9±6.6u/L,31.6±22.9u/L and 0.2_±0.1,in group B were 36.5±26.7u/L,39.9±30.8u/L and 0.3±0.2,and in group C were 44.3±11.6u/L,47.3± 49.3u/L and 0.4±0.3 （P〈0.05）;The hepatic G2 of inflammation in group A was 16.2%,much lower than in group B（35.3%）and in group C（30.0%,P〈0.05）,while there was no significantly different as respect to the liver fibrosis in the three gIuops（P〉0.05）. Conclusion In hepatitis B infected patients with low serum ALT level,the liver inflammation grades are dramatically different and may require different strategies of managements.

关 键 词：慢性乙型肝炎 丙氨酸氨基转移酶 肝活检 病理学 

分 类 号：R512.62[医药卫生—内科学]