低乙型肝炎病毒载量e抗原阴性的慢性乙型肝炎病毒感染者的肝组织学研究  

Liver histological changes in patients with hepatitis B e antigen-negative chronic hepatitis B virus infection with low hepatitis B virus load

作　　者：肖丽[1] 李阳[1] 杨秀珍[1] 耿爱文[1] 何义林[2] 叶茂聪 徐洪涛[1] 咸建春[1] Xiao Li;Li Yang;Sang Xiuzhen;Geng Aiwen;He Yilin;Ye Maocong;Xu Hongtao;Xian Jianchun(Department of Infectious Diseases,Taizhou People's Hospital,Taizhou 225300,China)

机构地区：[1]江苏省泰州市人民医院肝病科,225300 [2]江苏省泰州市疾病预防控制中心

出　　处：《中华传染病杂志》2018年第11期648-653,共6页Chinese Journal of Infectious Diseases

基　　金：中国肝炎防治基金会天晴肝病研究基金项目(CFHPC20132110).

摘　　要：目的探讨低乙型肝炎病毒基因载量(HBVDNA<4.3lgIU/mL)e抗原(HBeAg)阴性慢性HBV感染者[HBeAg-negativechronichepatitisBinfectedpatient,HBeAg(-)CHBI]有抗病毒适应证的预测因素。方法回顾性分析179例HBeAg(-)CHBI。肝病理的组织学活动指数(HAI)和纤维化分期(S)按KnodellHAI记分系统评价,以"HAI>3和(或)S≥3"为有治疗适应证。单变量因素分析和多元回归分析筛选治疗适应证的预测因素,使用受试者工作特征曲线(receiveroperatingcurves,ROC)和曲线下面积(areaundercurve,AUC)确定预测因素的优劣。结果HAI>3者81例(45.3%),S≥3者72例(40.22%),有抗病毒治疗适应证的患者比例为54.7%。多因素分析显示,年龄、γ-GT、血小板计数与血清白蛋白(Alb)与肝组织损害程度以及是否需要抗病毒治疗密切相关(均P<0.05)。年龄、血小板计数、γ-GT和Alb的AUC分别为0.655、0.657、0.726和0.65,对应的约登指数分别为0.297、0.426、0.03和0.012,对预测HBeAg(-)CHBI有治疗适应证的灵敏度分别0.643、0.842、0.705和0.653。结论54.7%的低HBV载量HBeAg(-)CHBI存在显著的肝组织学变化并有抗病毒治疗的必要性。年龄大、γ-GT升高、血小板计数减少和Alb下降是低HBV载量HBeAg(-)CHBI治疗适应证的预测因素。ObjectiveTo determine the predictive factors for antiviral therapy in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection [HBeAg(-) CHBI] patients with HBV DNA<4.3 lg IU/mL.MethodsA total of 179 HBeAg(-) CHBI patients were retrospective analyzed. Histology activity index (HAI) and fibrosis (S) were scored according to the Knodell HAI scoring system, and HAI>3 and/or S≥3 was adopted as indications for treatment. Univariate and multiple regression analysis were used to assess factors associated with treatment indications. Receiver operating curves (ROC) and area under curve (AUC) were used to determine the predictive value of relevant factors.ResultsThere were 81 cases with HAI>3 (45.3%) and 72 with S≥3 (40.22%), and the proportion of patients with indications for treatment was 54.7%. Multiple regression analysis showed that age, γ-glutamyl transpeptadase (γ-GT), platelet (PLT) and albumin (Alb) were the predictive factors for the severity of liver damage and indication for treatment (all P<0.05). The AUC for age, PLT, γ-GT and Alb were 0.655, 0.657, 0.726 and 0.65, respectively, and the corresponding Yoden index for age, PLT, γ-GT, and Alb were 0.297, 0.426, 0.03 and 0.012, respectively, the sensitivities of predicting HBeAg(-)CHBI for treatment indications were 0.643, 0.842, 0.705 and 0.653, respectively.ConclusionsThis study shows that 54.7% of HBeAg(-)CHBI patients with HBV DNA<4.3 lg IU/mL have significant liver histological changes and require antiviral treatment. Older age, higher γ-GT, lower PLT and lower Alb levels are the predictive factors for treatment.

关 键 词：肝炎 乙型 慢性 肝炎e抗原 乙型 病毒载量 肝活组织检查 

分 类 号：R512.62[医药卫生—内科学]