慢性HBV携带者早期肝硬化诊断的预测因素  

Predictive factors of early diagnosis of liver cirrhosis in chronic HBV carriers

作　　者：孙海英[1] 王明[1] 吕胜军[1] 张淑芹[1] 陈彤彤[1] 

机构地区：[1]吉林省肝胆病医院感染性疾病科,长春130062

出　　处：《中国肝脏病杂志（电子版）》2017年第4期82-85,共4页Chinese Journal of Liver Diseases：Electronic Version

基　　金：吉林省卫生计生委科研计划项目(2013ZC044)

摘　　要：目的分析40岁以上慢性HBV携带者早期肝硬化诊断的预测因素。方法选取2012年8月至2015年8月于吉林省肝胆病医院行肝组织活检的≥40岁慢性HBV携带者442例中肝脏炎症及纤维化分级分期为G4S4(肝硬化组,89例)和G2S2以下(对照组,183例)的患者289例为研究对象,对两组患者的肝功能、末梢血细胞计数、HBV DNA、HBs Ag定量及Fibroscan等指标进行分析。结果肝硬化组患者的年龄、HBV感染史、BMI及饮酒者比例均显著高于对照组,差异有统计学意义(P均<0.05)。肝硬化组患者的ALT、AST、ADA、GGT、ALP及PALB分别为(32.9±7.4)U/L、(31.2±10.3)U/L、(31.4±10.1)U/L、(72.7±31.6)U/L、(198.7±32.8)U/L、(112.9±31.4)g/L;对照组上述指标分别为(15.3±3.6)U/L、(29.8±9.7)U/L、(10.7±1.2)U/L、(22.6±9.7)U/L、(102.8±12.7)U/L及(311.7±89.8)g/L,差异有统计学意义(P均<0.05)。PLT<110×10~9/L及NEUT<2.0×109/L为肝硬化发生的独立危险因素(OR值分别为29.33、14.42,P<0.05)。Fibroscan与肝组织活检结果的一致性较好,Kappa值为0.75。HBV DNA水平及HBs Ag定量与肝硬化发生无关。结论对于年龄≥40岁的慢性HBV携带者,患者的年龄、感染HBV时间、肥胖、饮酒、PLT<110×10~9/L及NEUT<2.0×10~9/L为肝硬化的危险因素。Fibroscan检测与肝组织活检诊断肝硬化的一致性较好。Objective To explore the predictive factors of early diagnosis of liver cirrhosis in chronic HBV carriers （≥ 40 years old）. Methods Total of 442 chronic HBV carriers （≥ 40 years old） underwent liver biopsy in Hepatology Hospital of Jilin Province form August 2012 to August 2015, the fbrosis stage of 89 cases were G4S4 （liver cirrhosis group） and 194 cases were below G2S2 （control group）, these 283 cases were selected as investigate objects. Liver function, peripheral blood cell counts, HBV DNA levels, HBsAg quantitative and Fibroscan in both groups were analyzed and compared. Results The age, history of HBV infection, BMI and proportion of drinkers in liver cirrhosis group were higher than those in control group, the difference were statistically signifcant （P 〈 0.05）. The ALT, AST, ADA, ALP, GGT and PALB of patients in liver cirrhosis group were （32.9 ± 7.4） U/L, （31.2 ± 10.3） U/L, （31.4 ± 10.1） U/L, （72.7 ± 31.6） U/L, （198.7 ± 32.8） U/L and （112.9 ± 31.4） g/L, respectively; the corresponding indicators of patients in control group were （15.3 ± 3.6） U/L, （29.8 ± 9.7） U/L, （10.7 ± 1.2） U/L, （22.6 ± 9.7） U/L, （102.8 ± 12.7） U/L and （311.7 ± 89.8） g/L, respectively,the differences were statistically signifcant （P 〈 0.05）. PLT 〈 110 × 10^9/L and NEUT 〈 2.0 × 10^9/L were independent risk factors for liver cirrhosis （OR = 29.33, 14.42, P 〈 0.05）. Fibroscan showed good coherence with liver biopsy, and Kappa value was 0.75. HBV DNA levels and HBsAg had no correlation with liver cirrhosis. Conclusion For chronic HBV carriers over 40 years, the age, history of hepatitis B, obesity, alcohol intake, PLT 〈 110 × 10^9/L and NEUT 〈 2.0 × 10^9/L were risk factors for liver cirrhosis. Fibroscan showed good coherence with liver cirrhosis.

关 键 词：慢性HBV携带者 肝硬 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]