ALT持续正常的慢性HBV感染者82例肝脏病理与临床分析  

Liver histopathology and clinical characteristics in the chronic hepatitis B patients with persistently normal alanine aminotransferase levels:an analysis of 82 cases

作　　者：刘健[1] 洪仲思[1] 周耀勇[1] 

机构地区：[1]中山大学附属第五医院感染科,广东珠海519000

出　　处：《中华临床医师杂志（电子版）》2014年第13期43-46,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析ALT持续正常的慢性HBV感染者的肝脏病理与临床关系,为抗病毒治疗提供依据。方法回顾性分析82例ALT持续正常的慢性HBV感染者肝脏病理情况,根据肝组织不同炎症及纤维化分组,对比各组性别、年龄、家族史、HBV-DNA水平、HBeAg状态差异。结果 82例患者中,100%(82/82)存在不同程度的炎症活动,其中58.5%(48/82)的患者炎症活动度≥G2;57.3%(47/82)存在不同程度的纤维化,其中43.9%(36/82)的患者纤维化分期≥S2;纤维化分期与炎症分级相关(r=0.428,P<0.01);不同炎症分级患者的性别、年龄、家族史、HBV-DNA水平、血清HBeAg比较无统计学差异;不同纤维化分期患者年龄随纤维化分期的增加呈增大趋势,其中S2、S3组年龄(>40岁)与S0组相比,差异具有统计学意义(P<0.05),余性别、家族史、HBV-DNA水平、血清HBeAg表达比较无统计学差异。结论对于ALT水平持续正常的慢性HBV感染者,特别是年龄>40岁,可能存在不同程度的肝组织病理学改变,应积极考虑行肝穿刺活检,及时确定抗病毒治疗时机。Objective To study the liver histological changes in chronic hepatitis B（CHB） patients with persistently normal serum alanine aminotransferase （ALT） levels and the related clinic factors, providing the basis for antiviral therapy.Methods 82 CHB patients with persistently normal ALT were included in this study. Their liver histological changes and the relationship between these changes and sex, age, family history, HBV-DNA level, HBeAg status of patients were retrospectively analyzed. Results Among these 82 patients, 100%（82/82） had different degrees of inflammatory activity, of whom 58.5% （48/82） was higher than or equal to grade 2; 57.3%（47/82） had different degrees of fibrosis, of whom 43.9% （36/82） were higher than or equal to stage 2.Stage of fibrosis correlated positively with grade of inflammation（r=0.428,P〈0.01）. There were no significant differences between different grades of inflammation in patients with gender, age, family history, the level of serum HBV-DNA, HBeAg status. Age increased as the stage of fibrosis increased, and there were significant differences between S2, S3 （age〉40 years） and S0. But there were no significant differences between different stages of fibrosis in patients with gender, family history, the level of serum HBV-DNA, HBeAg status.Conclusion There may be different degrees of liver histopathology in chronic hepatitis B patients with persistently normal ALT levels, especially those older than 40 years, should be considered for liver biopsy, in order to determine the timing of antiretroviral therapy without delay.

关 键 词：肝炎 乙型 慢性 丙氨酸转氨酶 病理学 

分 类 号：R512.62[医药卫生—内科学]