慢性乙型肝炎患者肝脏炎症活动度和纤维化程度的影响因素  

Influence factors of liver inflammation activity and fibrosis of patients with chronic hepatitis B

作　　者：杜庆玮[1] 李明慧[2] 徐婷燕[1] 谢尧[2] 丁继光[1] 洪亮[1] 周克[1] 陈威[1] 周青青[1] 孙庆丰[1] 

机构地区：[1]温州医科大学附属第三医院感染科,浙江省瑞安市325200 [2]首都医科大学附属北京地坛医院肝病中心

出　　处：《中华传染病杂志》2015年第2期65-70,共6页Chinese Journal of Infectious Diseases

基　　金：温州市科技计划资助项目（Y20130189）

摘　　要：目的 探讨CHB患者肝脏炎症活动度（G）和纤维化程度（S）的影响因素.方法 对971例CHB患者进行肝组织病理学检查,同时收集患者的血生物化学、血常规、HBV DNA、HBV血清学标志物等数据.计数资料比较采用卡方检验,3组间计量资料的比较采用单因素方差分析,两组间计量资料的比较采用Student-t检验,相关性分析采用Spearman相关分析和多元回归分析.结果 971例患者分成3组.1年内ALT 3次持续正常列为A组,首次发现ALT升高者列为B组,半年内ALT升高两次以上者列为C组.A组332例,B组341例,C组298例.3组HBV感染者男性人数分别占47.9％、74.2％、73.8％,差异有统计学意义（x2=64.778,P＜0.01）.A组中HBeAg阳性者161例（48.5％）,B组234例（69.0％）,C组176例（59.1％）,差异有统计学意义（x2=28.325,P＜0.01）.3组G≥2者分别占36.4％、56.9％、51.3％（x2=29.868,P＜0.01）,S≥2者分别为25.3％、35.5％、35.9％（x2=10.807,P=0.005）.A组G≥2和（或）S≥2的有137例（41.3％）,B组有208例（61.0％）,C组有164例（55.0％）,差异有统计学意义（x2 =22.235,P＜0.01）.将A组分为ALT＜30 U/L组（229例）和ALT≥30 U/L组（103例）,两组间男性、HBeAg阳性、G≥2和（或）S≥2患者比例的差异均有统计学意义（均P＜0.05）.Spearman相关分析和Logistic回归分析显示,年龄≥35岁、ALT≥30 U/L、AST≥25 U/L、HBeAg阳性、血小板计数与显著病理学改变相关（均P＜0.05）,年龄（OR=2.012,95％CI为1.196～3.383）、HBeAg（OR=2.188,95％CI为1.339～3.584）和AST（OR=2.312,95％CI为1.390～3.846）为显著病理学改变的独立预测因素.结论 对ALT首次发现升高者,其显著肝脏组织病理学改变比例与反复升高的患者相似,建议早期抗病毒治疗.对ALT持续正常的感染者,年龄≥35岁、HBeAg阳性或AST≥25 U/L为显著病理学改变的独立预测因素,对符合上述条件的患者更应引起注意,进行早期的抗病毒治�Objective To analyze the influence factors of liver inflammation activity and fibrosis of patients with chronic hepatitis B （CHB） infection.Methods A total of 971 patients with chronic hapatitis B virus （HBV） infection,who underwent liver biopsy and routine laboratory testing,such as biochemical tests,blood routine examination,HBV DNA and serum hepatitis markers,were recruited.Categorical data were analyzed by Chi-square test.Quantitative data among three groups were compared by one-way analysis of variance.Quantitative data between two groups were compared by Student-t test,Spearman correlation analysis and multiple regression analysis.Results Nine hundred and seventy-one patients were divided into three groups including group A （more than three continuous normal alanine aminotransferase [ALT] within a year,n=332）,group B （first elevated ALT,n=341） and group C （more than two or more elevated ALT within six months,n=298）.The male patients in three groups were 47.9 %,74.2 % and 73.8%,respectively,with statistical significance （x2 =64.778,P〈0.01）.Hepatitis B e antigen （HBeAg）-positive patients in groups A,B and C were 161 （48.5%）,234（69.0%） and 176（59.1%）,respectively.The difference was statistically significant in three groups （x2 =28.325,P〈0.01）.The proportions of patients with G≥2 in three groups were 36.4%,56.9% and 51.3%,respectively （x2 =29.868,P〈0.01） ; and those of S≥2 were 25.3 %,35.5 % and 35.9 %,respectively （x2 =10.807,P=0.005）.The proportions of patients with G≥2 and （or） S≥2 in three groups were 137（41.3%）,208 （61.0%） and 164（55.0%）,respectively.The differences were significant among three groups （x2=22.235,P〈0.01）.Group A was divided into subgroup A1 （ALT〈30 U/L） with 229 cases and subgroup A2 （ALT≥30 U/L） with 103 cases.Differences of proportions of male,patients with HBeAg positivity and G≥2 and （or） S≥2 were statistically significant between sub groups A1 and A2 （all P〈0.05）.The Spearm

关 键 词：丙氨酸转氨酶 肝炎 乙型 病理学 

分 类 号：R512.62[医药卫生—内科学]