高病毒载量且ALT水平正常或轻度升高CHB患者临床和组织病理学特征  

Clinical and histopathological features of CHB patients with high viral load but normal or slightly elevated ALT levels

作　　者：徐芳 张海泉 赵佳强 XU Fang;ZHANG Hai-quan;ZHAO Jia-qiang(Department of Laboratory,Zhuhai People′s Hospital,Guangdong 519000,China;Department of Anesthesiology,Zhuhai People′s Hospital,Guangdong 519000,China)

机构地区：[1]珠海市人民医院(暨南大学附属珠海医院)检验科,广东519000 [2]珠海市人民医院(暨南大学附属珠海医院)麻醉科,广东519000

出　　处：《肝脏》2021年第11期1228-1230,共3页Chinese Hepatology

基　　金：珠海市科技计划项目(20171009E030093)。

摘　　要：目的分析高HBV DNA病毒载量、ALT水平正常或轻度升高的CHB患者临床和组织病理学特征。方法纳入2016年1月至2020年9月珠海市人民医院诊治的CHB患者378例,男性206例,女性172例,年龄(34.8±6.4)岁。采用Scheuer评分系统、组织学活动指数评价患者肝纤维化分期(F0~F4)及肝组织炎症活动度分级(G0~G4)。计量资料采用t检验;计数资料采用卡方检验。结果CHB患者中<F2期135例,≥F2期243例,<F2期患者年龄、HBV DNA、ALT、APRI及γ-谷氨酰转肽酶/血小板技术模型(GPR)分别为(32.8±9.2)岁、(8.4±1.0)log_(10)拷贝/mL、(45.8±5.5)U/L、(0.40±0.22)及(0.12±0.07),与≥F2期[(35.6±5.3)岁、(7.6±1.3)log_(10)拷贝/mL、(56.8±7.0)U/L、(0.49±0.20)及(0.17±0.08)]比,差异具有统计学意义(P<0.05)。CHB患者中<G2期142例,≥G2期236例,<G2期患者年龄、HBV DNA、ALT、AST、FIB-4、APRI及GPR分别为(33.6±8.4)岁、(8.4±1.1)log_(10) copies/mL、(46.1±5.4)U/L、(32.5±8.2)U/L、(0.19±0.11)、(0.40±0.23)及(0.12±0.08),与≥F2期[(35.2±7.5)岁、(7.4±1.4)log_(10)拷贝/mL、(56.0±6.8)U/L、(38.7±5.5)U/L、(0.24±0.11)、(0.55±0.22)及(0.17±0.10)]比,差异具有统计学意义(P<0.05)。结论对于年龄较大、病毒载量持续上升或FIB-4、APRI、GPR异常的ALT正常或轻度升高CHB患者需要加强随访,必要时进行肝穿刺活检。Objective To analyze the clinical and histopathological features of chronic hepatitis B(CHB)patients with high HBV DNA viral load but normal or slightly elevated alanine aminotransferase(ALT)levels.Methods Three hundred and seventy-eight CHB patients aged(34.8±6.4)years including 206 males and 172 females were collected from January 2016 to September 2020.Scheuer scoring system and histological activity index were used to evaluate the stage of liver fibrosis(F0~F4)and the grade of inflammatory activity of liver tissue(G0~G4).Measurement data are analyzed by t-test;counting data were analyzed by Chi-square test.Results The age,HBV DNA load,ALT level,Aspartate aminotransferase-to-Platelet Ratio Index(APRI),and gamma-glutamyl transpeptidase to platelet ratio(GPR)for patients<F2 stage were(32.8±9.2)years,(8.4±1.0)log_(10)copies/mL,(45.8±5.5)U/L,(0.40±0.22)and(0.12±0.07),respectively,compared with those of(35.6±5.3)years,(7.6±1.3)log_(10)copies/mL,(56.8±7.0)U/L,(0.49±0.20)and(0.17±0.08)for patients≥F2 stage,respectively,the difference was statistically significant(P<0.05).The age,HBV DNA,ALT,AST,FIB-4,APRI and GPR for patients<G2 stage were(33.6±8.4)years,(8.4±1.1)log_(10)copies/mL,(46.1±5.4)U/L,(32.5±8.2)U/L,(0.19±0.11),(0.40±0.23),(0.12±0.08),respectively,compared with those of(35.2±7.5)years,(7.4±1.4)log_(10)copies/mL,(56.0±6.8)U/L,(38.7±5.5)U/L,(0.24±0.11),(0.55±0.22),(0.17±0.10)for patients≥F2 stage,respectively,the difference was statistically significant(P<0.05).Conclusion It is necessary to strengthen the follow-up if the CHB patients are in older age,have normal or slightly elevated ALT,but have continuously increased viral load or abnormal FIB-4,APRI and GPR.Liver biopsy need to be performed whenever necessary.

关 键 词：慢性乙型肝炎 丙氨酸氨基转移酶 肝纤维化 肝组织炎症活动度 

分 类 号：R512.62[医药卫生—内科学]