肝功能正常的慢性HBV感染者的临床特征及肝脏病理学分析  

Clinical features and liver pathology in chronic hepatitis B virus-infected patients with normal liver function

作　　者：陈丽[1] 周兴蓓 温丹凤 於学军 杨丽君[1] 孙莉[1] 谭友文[1] 

机构地区：[1]江苏大学附属镇江市第三人民医院肝病科,江苏镇江212000

出　　处：《临床肝胆病杂志》2015年第9期1430-1433,共4页Journal of Clinical Hepatology

基　　金：江苏省自然科学基金(BK2011515)

摘　　要：目的了解肝功能正常的慢性HBV感染者的临床特点和肝脏病理学及其影响因素。方法收集2008年8月-2012年8月在江苏大学附属镇江市第三人民医院诊治的肝功能正常的慢性HBV感染者316例,采用超声定位穿刺取肝组织,行HE染色、纤维Masson染色,HBs Ag和抗-HBc免疫组化染色,观察Knodell坏死炎症评分和Ishak纤维化评分,并分别分析其与年龄、性别、HBe Ag状态、ALT水平、血清HBV DNA复制水平以及HBs Ag和HBc Ag肝组织表达的关系。计量资料两组间比较采用t检验,多组间比较采用单因素方差分析,进一步两两比较采用SNK-q检验;计数资料组间比较采用χ2检验。结果肝功能正常的慢性HBV感染者中有260例（82.3%）炎症坏死中度以上,中度纤维化以上有256例（81.0%）;重度炎症坏死和重度纤维化（肝硬化）分别为13例（4.1%）和26例（8.2%）。女性平均年龄大于男性（t=3.526,P〈0.05）,并且其Knodell评分和Ishak评分均高于男性（t值分别为6.65、5.77,P值均〈0.05）;30岁以上的慢性HBV感染者其Knodell评分和Ishak评分高于30岁以下患者（P值均〈0.05）。ALT水平为0.5~1.0倍正常值上限（ULN）的HBV感染者其肝组织损伤程度比（0~0.49）×ULN的HBV感染者严重（P值均〈0.05）。从HBV DNA复制水平来看,处于检测下限的患者其肝组织损伤程度明显低于病毒载量大于检测下限的病例组,差异具有统计学意义（P值均〈0.05）;HBs Ag和HBc Ag肝组织表达的强弱与肝组织损伤相关性并不大,差异无统计学意义（P值均〈0.05）。结论可检测到病毒载量的持续ALT正常的慢性HBV感染者应考虑进行肝活组织检查,特别是年龄〉40岁的患者。Objective To study the clinical features and liver pathoh）gy in chronic hepatitis B （HBV） -infected patients with normal liver function, and to explore the influencing factors. Methods A total of 316 chronic HBV - infected patients with normal liver function who were admitted to our hospital from August 2008 to August 2012 were enrolled as subjects. Hepatic tissue was collected by ultrasound - guided biopsy and analyzed by hematoxylin -eosin staining, Masson staining, and anti -HBsAg and anti -HBcAg immunohistochemistry staining. The Knodell inflammatory score and Ishak fibrosis score were evaluated, and their relationships with age, gender, HBeAg, alanine amin- otransferase （ALT） level, serum HBV DNA replication, and hepatic expressinn of HBsAg and FIBcAg were analyzed. Comparisons of con- tinuous data between two groups and between multiple groups were performed by t test and one - way analysis of variance, respectively. The further pairwise comparison was performed by SNK - q test. Comparison of categorical data was performed byx2 test. Results In all the chronic HBV - infected patients with normal liver function, there were 260 （ 82.3% ） patients with at least moderate inflammation and necrosis, 256 （81.0%） patients with at least moderate fibrosis, 13 （4.1% ） patients with severe inflammation and necrosis, and 26 （8.2%） patients with severe fibrosis （cirrhosis）. The average age, Knodell score, and Ishak score were significantly higher in the female palients than in the male patients （ t = 3. 526, P 〈 0.05 ; t = 6.65, P 〈 0. 05 ; t = 5.77, P 〈 0.05 ）. The chronic HBV - infected patients older than 30 years of age had significantly higher Knodell and Ishak scores than those younger than 30 years of age （ both P 〈 0.05 ）. Moreover, the degree of liver injury was significantly higher in the infected patients with an ALT level of （0.5 - 1 ） × upper limit of normal （ULN） than in those with an ALT level of （0 - 0.49） × ULN （ P 〈 0.05 ）. Patients with

关 键 词：肝炎 乙型 慢性 病理学 临床 肝功能试验 

分 类 号：R512.62[医药卫生—内科学]