91例丙氨酸氨基转移酶低于正常值上限二倍的慢性乙型肝炎患者肝组织病理特征与实验室指标的相关性  

Correlation between liver pathological features and laboratory parameters of 91 patients of chronic hepatitis B with alanine aminortransferase lower than 2×upper limits of normal

作　　者：施文娟[1] 张妍[1] 王兆勋[1] 万红[1] Shi Wenjuan;Zhang Yan;Wang Zhaoxun;Wan Hong(Department of Infectious Diseases,The Sencond People’s Hospital of Lanzhou,Lanzhou 730046,China)

机构地区：[1]兰州市第二人民医院感染科,兰州市730046

出　　处：《中华实验和临床感染病杂志（电子版）》2020年第2期138-143,共6页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：兰州市科技计划项目(No.2017-4-20)。

摘　　要：目的分析丙氨酸氨基转移酶(ALT)<正常值上限2倍(2×ULN)慢性乙型肝炎(CHB)患者肝组织病理特征与实验室指标的相关性。方法收集兰州市第二人民医院2017年1月至2019年5月住院的ALT<2×ULN、HBV DNA阳性、进行肝脏活体组织活检的CHB患者共91例,根据肝组织活检结果将G2以下者定为轻度炎症组(61例),G2及以上者定为中度炎症组(30例);S2以下者定为无明显纤维化组(69例),S2及以上者定为明显纤维化组(22例),分别将炎症两组、纤维化两组患者的血细胞、肝生化指标、凝血指标、乙型肝炎病毒标志物(HBV M)、HBV DNA进行对比分析(Wilcoxon W检验和χ^2检验)与相关性研究(φ相关分析)。结果91例患者肝组织轻度炎症组与中度炎症组ALT、天门冬氨酸氨基转移酶(AST)、球蛋白(GLO)和乙型肝炎病毒e抗原(HBe Ag)阳性率差异均有统计学意义(Z=2.095、P=0.036,Z=3.927、P<0.001,Z=2.900、P=0.004,χ^2=10.972、P=0.001)。无明显纤维化组与明显纤维化组患者AST、GLO、白细胞(WBC)、血小板(PLT)和HBe Ag阳性率差异均有统计学意义(Z=2.933、P=0.003,Z=3.064、P=0.002,Z=2.544、P=0.011,Z=2.231、P=0.026,χ^2=10.116、P=0.001)。HBV DNA水平在肝组织轻度炎症组和中度炎症组、无明显纤维化组和明显纤维化组间差异均无统计学意义(Z=1.908、P=0.056,Z=1.729、P=0.084)。ALT、AST与肝组织炎症活动度低度相关(rφ=0.211、P=0.044;rφ=0.284、P=0.007);AST、WBC与肝组织纤维化程度低度相关(rφ=0.222、P=0.035,rφ=0.289、P=0.006);GLO与肝组织纤维化程度中度相关(rφ=0.457、P<0.001)。结论对于ALT<2×ULN、HBV DNA阳性的CHB患者,HBeAg阳性者较阴性者发生肝纤维化的机率高;WBC、PLT、AST、GLO水平与肝组织纤维化程度有关,其中GLO水平>30 g/L的患者与肝组织肝纤维化的相关性更高。Objective To analyze the correlation between liver pathological features and laboratory parameters of chronic hepatitis B(CHB)patients with alanine aminortransferase(ALT)<2×upper limits of normal(ULN).Methods Total of 91 patients with CHB of ALT<2×ULN who underwent liver puncture in the Sencond People’s Hospital of Lanzhou from January 2017 to May 2019 were collected.According to the results of liver penetrating examination,61 cases with G2 lower were classified as mild inflammation group,and 30 cases with G2 and above were as moderate inflammation group;69 cases with S2 lower were as no obvious fibrosis group,and 22 cases with S2 or above were as obvious fibrosis group.Two groups of inflammation and fibrosis patients were respectively compared with blood cells(WBC),liver biochemical indicators,international standard ratio(INR),hepatitis B virus marker(HBV M)and HBV DNA through comparative analysis(Wilcoxon W test andχ^2 test)and correlation analysis(φcorrelation analysis).Results Levels of ALT,aspartate aminortransferase(AST),globulin(GLO)and hepatitis B virus e antigen(HBeAg)positive rate were significantly different between the patients in mild inflammation group and moderate inflammation group(Z=2.095,P=0.036;Z=3.927,P<0.001;Z=2.900,P=0.004;χ^2=10.972,P=0.001).The levels of AST,GLO,WBC,platelet(PLT)and HBeAg positive rate were significantly different between the patients in no significant fibrosis group and obvious fibrosis group(Z=2.933,P=0.003;Z=3.064,P=0.002;Z=2.544,P=0.011;Z=2.231,P=0.026;χ^2=10.116,P=0.001).HBV DNA levels were not significantly different among groups of different liver tissue inflammatory activity and fibrosis degree(Z=1.908,P=0.056;Z=1.729,P=0.084).The levels of ALT and AST were associated with low degree of inflammatory activity in liver tissue(rφ=0.211,P=0.044;rφ=0.284,P=0.007).The levels of AST and WBC were associated with low degrees of liver fibrosis(rφ=0.222,P=0.035;rφ=0.289,P=0.006).The level of GLO was moderately correlated with liver fibrosis(rφ=0.457,P<0.001).Conc

关 键 词：肝炎 乙型 慢性 肝组织病理特征 实验室指标 相关性 

分 类 号：R512.62[医药卫生—内科学]