ALT持续正常及持续或间断升高的慢性乙型肝炎患者肝脏硬度值分析  

Analysis of liver stiffness measurement in chronic hepatitis B patients with persistently normal ALT and persistently or intermittently elevated ALT

作　　者：钟曼华 梁携儿[1] 陈永鹏[1] 杨淑玲[1] 彭劼[1] 谭文娟[1] 于文轩[1] 孙剑[1] 

机构地区：[1]南方医科大学附属南方医院感染内科/肝病中心,广州510515

出　　处：《临床肝胆病杂志》2014年第4期349-353,共5页Journal of Clinical Hepatology

基　　金：国家科技重大专项(2012ZX10002-003)

摘　　要：目的目前ALT持续正常(PNALT)以及持续或间断升高(PIEALT)的慢性乙型肝炎(CHB)患者肝脏硬度值(LSM)的数据十分有限。本研究对该组患者LSM范围及其影响因素进行了探讨,以供临床应用参考。方法将在2012年9月-2013年3月于本院就诊的208例初治CHB患者纳入研究,均接受瞬时弹性扫描仪(FS)检查。PNALT组:在最近1 a随访至少3次,每次间隔2个月以上,ALT水平均正常,入组时ALT正常;PIEALT组进一步分为ALT轻度升高(过去1 a随访中ALT水平至少有1次升高但<2×ULN)以及ALT明显升高(过去1 a随访中ALT水平至少有1次升高>2×ULN),入组时ALT<2×ULN。根据现有的研究结果,当ALT<2×ULN时,用于诊断以及排除进展性肝纤维化的标准分别为LSM≥10.6 kPa和LSM<7.4 kPa。计量资料分析采用t检验、方差分析和秩和检验,计数资料采用χ2检验,相关因素采用双变量相关分析及Logistic回归分析。结果受试人群平均LSM为(6.2±2.9)kPa。在PNALT患者中,LSM≥7.4 kPa占14.3%(18/126),LSM≥10.6 kPa占2.4%(3/126)。在总体PIEALT患者中,这个比例分别是35.4%(29/82)以及13.4%(11/82)。多元回归分析中,ALT>1×ULN(OR=2.63,P=0.037)、男性(OR=5.29,P=0.012)是LSM≥7.4 kPa的独立影响因素;HBV DNA定量>5 log10拷贝/ml是LSM≥10.6 kPa唯一的独立影响因素(OR=13.84,P=0.046)。结论在PIEALT和PNALT的CHB患者中,分别有35%及14%的患者不能排除进展性肝纤维化的可能;大约13%的PIEALT患者根据LSM结果可判断为进展性肝纤维化。对于ALT>1×ULN、HBV DNA拷贝数的对数值大于5的男性CHB患者,建议对其进行密切随访。Objective Data on liver stiffness measurement （LSM） in chronic hepatitis B （CHB） patients with persistently normal alanine aminotransferase （ALT） （PNALT） and persistently or intermittently elevated ALT （PIEALT） were limited. In this study, we aimed to assess LSMs in these patients and determine the potential influential factors for LSMs, thus providing reference for clinical practice. Methods Two hundred and eight CHB patients without antiviral treatment during the previous one year with ALT 〈 2 × ULN were included. All of them underwent FibroScan. These patients were grouped according to the results of follow -ups performed at least three times （intervals 〉 2 months） in the past one year： group 1 （PNALT）, with ALT persistently less than 1 ×ULN; group 2 （PIEALT）, with ALT elevated to above 1 ×ULN but less than 2 ×ULN at least once; group 3 （PIEALT）, with ALT elevated to above 2 ×ULN at least once. According to previous studies, the LSM cut -off values to exclude and diagnose advanced liver fibrosis were 〈7.4 kPa and≥10.6 kPa in CHB patients with ALT 〈2 ×ULN. Results The moan ISM was 6.2 ±2.9 kPa. Of PNALT patients, 14.3% （18/126） had an LSM of ≥7.4 kPa, and 2.4% （3/126） had an LSM of ≥10.6 kPa; the proportions were 35.4% （29/82） and 13.4% （11/82） in all PIEALT patients. The multivariate regression analysis showed that ALT 〉 1 × ULN （OR =2. 63, P =0.037） and male （OR =5.29, P =0.012） were independently associated with LSM ≥7.4 kPa; HBV DNA ≥5 log 10 copies/ml was the independent predictor of ISM ≥ 10.6 kPa （ OR = 13. 84, P = 0. 046）. Conclusion Among CHB patients, 35% of PIEALT cases and 14% of PNALT cases might progress to advanced liver fibrosis; around 13% of patients with PIEALT could be diagnosed with advanced liver fibrosis. Close follow -ups are recommended for male CHB patients with ALT 〉 1 × ULN and HBV DNA ≥5 log10 copies/ml.

关 键 词：肝炎 乙型 慢性 谷丙酸转氨酶 肝脏硬度值 弹性成像技术 

分 类 号：R512.62[医药卫生—内科学]