低水平丙氨酸转氨酶慢性HBV感染者135例肝脏病理特征及影响因素分析  

Changes of liver pathology and its influencing factors in patients with chronic hepatitis B viral infection and low level of serum alanine aminotransferase:an analysis of 135 cases

作　　者：胡梦琳 潘爱萍 张雨 赵克开 洪侃 杨益大[2] 江军 Hu Menglin;Pan Aiping;Zhang Yu;Zhao Kekai;Hong Kan;Yang Yida;Jiang Jun(Department of Infectious Diseases,the Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,Zhejiang Province,China;Department of Infectious Diseases,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]宁波大学医学院附属医院感染科,315020 [2]浙江大学医学院附属第一医院感染病诊治中心传染病诊治国家重点实验室,杭州310003

出　　处：《中华临床感染病杂志》2020年第1期55-60,66,共7页Chinese Journal of Clinical Infectious Diseases

基　　金：国家“十三五”科技重大专项(2017ZX10202202)。

摘　　要：目的探讨低水平丙氨酸转氨酶(ALT)慢性HBV感染者肝脏病理发生明显组织学改变的危险因素。方法回顾性分析2017年7月至2019年7月于宁波大学医学院附属医院及浙江大学医学院附属第一医院住院的135例血清ALT水平低于2倍正常值上限(ULN)慢性HBV感染者的临床资料,对所有研究对象的肝脏病理结果进行统计,采用Logistic回归分析影响患者发生明显肝脏炎症(G≥2)或纤维化(S≥2)的危险因素。结果52例(52/135,38.5%)患者的肝组织G≥2或S≥2。单因素分析显示,年龄、HBV家族史、ALT 1~<2×ULN、天冬氨酸转氨酶(AST)≥1×ULN、血小板计数(PLT)降低、凝血酶原时间(PT)延长是低水平ALT慢性HBV感染者肝脏病理发生G≥2或S≥2的危险因素(P<0.05或<0.01);多因素Logistic回归分析显示,年龄(OR=1.052,95%CI 1.007~1.100)、HBV家族史(OR=5.448,95%CI 2.191~13.548)和AST(OR=1.042,95%CI 1.005~1.081)是低水平ALT慢性HBV感染者肝脏病理发生G≥2或S≥2的独立危险因素(P<0.05或<0.01)。结论对于ALT<2×ULN的慢性HBV感染者,年龄、HBV家族史和AST水平可作为判断肝脏病理组织严重程度和接受抗病毒治疗的依据。Objective To investigate the changes of liver pathology and its influencing factors in patients with chronic hepatitis B viral(HBV)infection and low level of serum alanine aminotransferase(ALT).Methods The clinical data of 135 with chronic HBV infection patients,in whom the serum ALT levels were less than two times of the upper limit of normal(ULN),were collected from the Affiliated Hospital of Medical School of Ningbo University and the First Affiliated Hospital,Zhejiang University School of Medicine during July 2017 and July 2019.The result of hepatic histological examination was reviewed,and the risk factors of obvious liver inflammation(G≥2)or fibrosis(S≥2)in patients were analyzed with Logistic regression analysis.Results The pathological examination of liver tissue revealed G≥2 or S≥2 in 52 cases(38.5%).The univariate analysis showed that age,family history of HBV infection,ALT 1-<2×ULN,aspartate aminotransferase(AST)≥1×ULN,low platelet count(PLT)and prolongation of prothrombin time(PT)were associated with G≥2 or S≥2 in chronic HBV infection patients with low level ALT(P<0.05 or<0.01).Multivariate Logistic regression analysis showed that age(OR=1.052,95%CI 1.007-1.100),family history of HBV infection(OR=5.448,95%CI 2.191-13.548)and AST(OR=1.042,95%CI 1.005-1.081)were independent risk factors of G≥2 or S≥2 in chronic HBV infection patients with low level ALT(P<0.05 or<0.01).Conclusion Age,family history of HBV infection and AST level can be used to judge the severity of liver pathological changes and necessity of antiviral treatment for patients with chronic HBV infection having ALT<2×ULN.

关 键 词：肝炎 乙型 慢性 肝脏病理 丙氨酸转氨酶 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学]