低丙氨酸氨基转移酶慢性乙型肝炎患者肝组织病理学变化及其影响因素分析  

Liver pathologic changes in chronic Hepatitis B patients with mildly elevated serum alanine aminotransferase levels after two-year followed-up

作　　者：陈学福[1] 陈小苹[1] 马晓军[1] 黄晶[1] 罗晓丹[1] 廖金瑶 岑爱群[1] 

机构地区：[1]广东省医学科学院/广东省人民医院感染病科,广州市510080

出　　处：《实用肝脏病杂志》2015年第6期594-597,共4页Journal of Practical Hepatology

基　　金：广东省科技计划项目(2011B031800150)

摘　　要：目的随访低丙氨酸氨基转移酶(ALT)慢性乙型肝炎患者肝组织病理学改变,探讨抗病毒治疗的疗效。方法选择167例ALT<2倍正常值上限(ULN)的慢性HBV感染者,其中HBV携带者88例和慢性乙型肝炎79例,给予后者聚乙二醇干扰素α-2a或者恩替卡韦治疗48 w,并随访2年,再次行肝穿刺检查,动态观察肝组织病理学、血清HBs Ag、HBe Ag、HBV DNA定量和ALT等指标,进行Logistic回归分析。结果在随访2年结束时,在88例HBV携带者中有33例(37.5%)肝组织病变进展,与55例(62.5%)无进展者比较,入组时进展组年龄为(39.7±7.6)岁,显著大于无进展组[(30.2±9.7)岁,P<0.05],而HBe Ag阳性率(51.5%)和HBs Ag水平[(3.22±0.51)lg IU/ml]明显低于无进展组[分别为(81.8%)和(3.50±0.53)lg IU/ml,P<0.05];Logistic回归分析显示年龄是肝组织病理学损伤进展的重要影响因素(OR=1.118,P=0.002);79例慢性乙型肝炎患者经抗病毒治疗,随访2年时有62例(78.5%)肝组织学改善。抗病毒治疗后肝组织炎症分级、纤维化分期和肝组织Knodell’s计分均有显著改善(x2=43.298,x2=26.232,x2=66.243,P<0.05)。结论随着年龄增长,HBe Ag阴性的低ALT水平的慢性HBV携带者肝组织病理学损伤进展的风险增加,及时进行肝组织学检查非常重要,可尽早发现病变并给予抗病毒治疗,而抗病毒治疗对延缓病情很有帮助。Objective To explore the liver pathologic changes in chronic Hepatitis B （CHB） patients with mildly elevated serum alanine aminotransferase levels after two-year followed-up. Methods 167 CHB patients with serum ALT〈2 upper limit of normal （ULN） who underwent liver biopsy were included in this study. The patients were followed-up for two years,and the liver biopsies were performed at presentation and at the end of two year observation. Serum HBsAg,HBeAg,HBV DNA and ALT were conventionally detected,and Logistic regression was conducted to find the influencing factors for the liver tissue pathology changes. Results 33 （37.5%） had,and 55 （62.5%） had not aggravated liver tissue injuries out of 88 hepatitis B virus carriers at the end of two year follow-up,the ages of those with aggravated liver injuries at presentation were（39.7±7.6） yr,older than in without liver injuries [（30.2±9.7）yr,P〈0.05],and the serum HBeAg positive rate （51.5%） and the serum level of HBsAg [（3.22±0.51 ） lglU/ml] were much lower than in those without liver injuries [（81.8%） and （3.50± 0.53） lgIU/ml,respectively,P〈0.05];The age was an important factor affecting liver pathological progress by Logistic regression analysis（OR=l.ll8,P=0.002）. 62（78.5%） had improved hepatic histological activity of Knodell＇s score in 79 patients with CHB after antiviral therapy at the end of two year follow-up. Conclusion The risk of liver tissue pathological progression increased as the hepatitis B virus carriers get older than 40 years in those with serum HBeAg negative and mildly elevated serum ALT levels,and we recommends them having liver biopsy in time,and have antiviral therapy as necessary.

关 键 词：乙型肝炎病毒携带者 慢性乙型肝炎 丙氨酸氨基转移酶 肝组织Knodell’s计分 抗病毒治疗 

分 类 号：R512.62[医药卫生—内科学]