ALT正常的慢性HBV感染者临床特征与肝组织学相关性研究  

Correlative study between liver histopathology and clinical features in HBV- infected patients with normal ALT level

作　　者：常海宁[1] 徐葵花[1] 赵守松[1] 

机构地区：[1]安徽省蚌埠医学院第一附属医院感染科,安徽蚌埠233000

出　　处：《中西医结合肝病杂志》2015年第3期141-144,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨丙氨酸氨基转移酶(ALT)正常的慢性HBV感染者临床特征与肝脏病理的相关性。方法:对ALT正常的105例慢性HBV感染者进行肝组织病理检查,并对血清HBV标志物(HBV-M)和HBV DNA等进行分析。结果:105例慢性HBV感染者中肝组织有病理改变者占93.3%(98/105),其中G2及G2以上者占17.1%(18/105),S2及S2以上占21.9%(23/105),且12.4%(13/105)的患者组织学表现为肝硬化。年龄与纤维化分期呈正相关(rs=0.21,P<0.05);0.5×ULN<ALT≤1×ULN和ALT≤0.5×ULN组肝组织炎症分级差异无显著性意义(P>0.05),但肝纤维化分期有差异显著性意义(P<0.05)。肝组织纤维化程度还与年龄和HBV DNA复制水平有关,而与HBeAg阳性与否无相关性。结论:部分ALT水平正常的慢性HBV感染者肝组织病变也处于活动期,其中年龄>41岁、0.5×ULN<ALT≤1×ULN、HBV DNA<105copies/ml的这部分患者应建议及时行肝穿刺检查并及时抗病毒治疗。判断ALT持续正常的慢性HBV感染者肝组织病变程度和是否抗病毒治疗的主要依据仍为肝穿刺活检。Objective： To evaluate the correlation between liver histopathology and clinical features in HBV-infected patients with normal ALT level. Methods： Pathological and examinations of liver tissue、serum HBV-M and HBVDNA detection were performed in 105 patients with HBV-infected patients. Result： Ninety-three point three percent（ 98 /105） patients with normal ALT level had abnormal liver histology,but significant pathohistological changes such as significant necroinflammation,fibrosis and cirrhosis were found in 34. 3%（ 36 /105） patients. 12. 4%（ 13 /105） patients had definitive cirrhosis. Age was positively correlated with fibrosis staging score（ rs= 0. 21,P〈0. 05）.Significantly difference（ P〈0. 05） in the grades of fibrosis was found between 0. 5 × ULN ALT ≤1 × ULN group and ALT ≤0. 5 × ULN group. No significant differences were observed in the grade liver inflammation with gender,level of ALT,HBV DNA and HBe Ag. Heoatic fiber proliferation of hepatic tissue were significantly increased with increasing age and level of ALT. Conclusions： Part of patients with chronic HBV-infected with normal ALT level have liver pathological changes. Older than 41 years old,patients with 0. 5 × ULN ALT≤1 × ULN and HBV DNA 〈105 copies / ml should suggest receive liver biopsy and antiviral treatment timely in chronic HBV-infected patients with normal ALT level.

关 键 词：慢性乙型肝炎病毒携带 丙氨酸转氨酶 肝/病理学 

分 类 号：R512.62[医药卫生—内科学]