低病毒载量HBV感染者肝脏炎症及纤维化情况分析  

Liver inflammation and fibrosis in HBV-infected patients with a low viral load

作　　者：姜曼蕾 许飞 张伦理[2] JIANG Manlei;XU Fei;ZHANG Lunli(Department of Difficult Hepatology,Ganzhou Fifth People’s Hospital,Ganzhou,Jiangxi 341000,China;Department of Infectious Diseases,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]赣州市第五人民医院疑难肝病科,江西赣州341000 [2]南昌大学第一附属医院感染科,南昌330006

出　　处：《临床肝胆病杂志》2023年第6期1304-1307,共4页Journal of Clinical Hepatology

基　　金：江西省卫生健康委科技基金项目(202212322);赣州市科技局基金项目(GZ2020ZSF294)。

摘　　要：目的探讨低病毒载量慢性HBV感染者肝脏炎症、纤维化情况。方法选取2019年4月-2022年6月赣州市第五人民医院就诊HBsAg阳性患者,筛选出20 IU/mL<HBV DNA<2000 IU/mL患者41例,完善血生化、肝硬度、肝穿刺病理检查,明确肝脏炎症和纤维化情况;根据HBV DNA、ALT、肝硬度值、年龄对比分析肝脏炎症情况。计数资料组间比较采用χ^(2)检验。结果36.59%(15/41)低病毒载量HBV感染者肝脏炎症和/或纤维化≥G2/S2。15例慢性乙型肝炎患者中,HBV DNA为>200~2000 IU/mL患者11例(73.33%),HBV DNA为20~200 IU/mL患者4例(2667%);肝脏炎症活动度分级G2占比73.33%(11/15)、纤维化程度分期S2占比46.67%(7/15);ALT≤30 U/L占比46.67%(7/15);年龄≥30岁占比86.66%(13/15);LSM>17 kPa占比6.67%(1/15),LSM 12.4~17 kPa占比4667%(7/15),LSM 9.4~12.4 kPa占比33.33%(7/15)。结论低病毒载量慢性HBV感染者有较高的炎症和纤维化进展风险;ALT水平不能作为低病毒载量HBV感染者是否抗病毒治疗的依据;瞬时弹性成像肝硬度检测可作为筛查低病毒载量慢性乙型肝炎患者的无创检查,当低病毒载量HBV感染者>30岁、肝硬度值持续>9.4 kPa时应考虑给予抗病毒治疗。Objective To investigate liver inflammation and fibrosis in patients with chronic HBV infection with a low viral load.Methods Among the HBsAg-positive patients who attended Ganzhou Fifth People’s Hospital from April 2019 to June 2022,41 patients with 20 IU/mL<HBV DNA<2000 IU/mL were selected and underwent the examinations of blood biochemistry,liver stiffness measurement(LSM),and liver biopsy to clarify liver inflammation and fibrosis.Liver inflammation was analyzed according to HBV DNA,alanine aminotransferase(ALT),LSM,and age.The chi-square test was used for comparison of categorical data between groups.Results Among the 41 patients,15(36.59%)had liver inflammation grade≥G2 and/or liver fibrosis stage≥S2.Among these 15 patients,11(73.33%)had an HBV DNA level of>200-2000 IU/mL and 4(26.67%)had an HBV DNA level of 20-200 IU/mL;the patients with G2 liver inflammation accounted for 73.33%(11/15),and those with S2 liver fibrosis accounted for 46.67%(7/15);the patients with ALT≤30 U/L accounted for 46.67%(7/15);the patients aged≥30 years accounted for 86.66%(13/15);the patients with LSM>17 kPa accounted for 6.67%(1/15),those with an LSM value of 12.4-17 kPa accounted for 46.67%(7/15),and those with an LSM value of 9.4-12.4 kPa accounted for 33.33%(5/15).Conclusion Patients with chronic HBV infection and low-level viremia have a relatively high risk of progression of inflammation and fibrosis.ALT level cannot be used as a basis for antiviral therapy in HBV-infected people with a low viral load.LSM based on transient elastography can be used as a noninvasive test to screen for CHB patients with a low viral load,and antiviral therapy should be considered when HBV-infected patients with a low viral load have an age of>30 years and an LSM value of>9.4 kPa persistently.

关 键 词：乙型肝炎 慢性 病毒载量 肝纤维化 

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