谷丙转氨酶正常乙肝e抗原阴性慢性乙型肝炎病毒感染特征分析及无创肝纤维化评估  

Characteristic analysis and evaluation of noninvasive liver fibrosis in HBeAg-negative chronic hepatitis B virus infection patients with normal alanine aminotransferase

作　　者：黄光明[1] 陈萍 程文会[1] 郝亚琴 HUANG Guangming;CHEN Ping;CHENG Wenhui;HAO Yaqin(Department of Gastroenterology,the Fifth People's Hospital of Chongqing,Chongqing400062,China)

机构地区：[1]重庆市第五人民医院消化内科,重庆400062

出　　处：《中国当代医药》2024年第27期42-45,共4页China Modern Medicine

基　　金：重庆市南岸区科技局决策咨询与管理创新研究计划项目(2020-08);重庆市南岸区卫生和计划生育委员会区级医学科研项目(2018-01)。

摘　　要：目的了解谷丙转氨酶(ALT)正常乙肝e抗原(HBeAg)阴性的慢性乙型肝炎病毒(HBV)感染者的临床特征并分析与无创肝纤维化检测的相关性。方法选取2019年11月至2022年11月在重庆市第五人民医院消化内科门诊就诊的105例ALT正常HBeAg阴性慢性HBV感染者作为研究对象,检测ALT、谷草转氨酶(AST)、血小板(PLT)、乙肝两对半及乙肝病毒DNA(HBVDNA)等指标,应用无创肝纤维化检测如AST和血小板比率指数(APRI评分)、肝纤维化4因子指数(FIB-4指数)、肝脏硬度值(LSM)评估肝纤维化。以LSM≥9.7 kPa作为进展期肝纤维化的阈值。结果ALT正常HBeAg阴性慢性HBV感染者以男性为主,占69.5%,平均年龄47.8岁,进展期肝纤维化66例,占62.9%。≥50岁者的HBVDNA、LSM分别与<50岁者比较,差异有统计学意义(P<0.05)。不同年龄组的FIB-4指数比较,差异有统计学意义(P<0.05)。HBVDNA高病毒载量组的年龄与低病毒载量组比较,差异有统计学意义(P<0.05)。HBVDNA高、中病毒载量组的LSM、FIB-4指数与低病毒载量组比较,差异有统计学意义(P<0.05)。肝纤维化组的性别、年龄、ALT、AST、PLT、HBVDNA、APRI评分、FIB-4指数与非肝纤维化组比较,差异有统计学意义(P<0.05)。APRI评分与LSM呈正相关(r=0.430,P<0.001);FIB-4指数与LSM呈正相关(r=0.464,P<0.001)。结论ALT正常HBeAg阴性慢性HBV感染者容易发生肝纤维化,男性、年龄较大者、HBVDNA病毒载量较高者发生肝纤维化的风险更大,APRI评分、FIB-4指数与LSM呈正相关。Objective To investigate the clinical features of HBeAg-negative chronic HBV infection patients with ALT and to analyze the correlation of noninvasive liver fibrosis detection.Methods A total of 105 HBeAg-negative chronic HBV infected patients with normal ALT were selected from the Gastroenterology Clinic in the Fifth People's Hospital of Chongqing from November 2019 to November 2022 as the study objects.The indexes of ALT,aspartate transaminase(AST),platelet(PLT),two-half hepatitis B and HBVDNA were detected.Noninvasive liver fibrosis detection such as AST to PLT ratio index(APRI score),fibrosis 4 score(FIB-4 index)and liver stiffness measurements(LSM)to evaluate liver fibrosis.LSM≥9.7 kPa was used as the threshold to indicate progressive liver fibrosis.Results The majority of patients with normal ALT and HBeAg-negative chronic HBV infection were male,accounting for 69.5%,with an average age of 47.8 years,and 66 patients with advanced liver fibrosis,accounting for 62.9%.HBVDNA and LSM were statistically significant between≥50 years old and<50 years old(P<0.05).The FIB-4 index of different age groups was statistically significant(P<0.05).The age of HBVDNA high viral load group was statistically significant compared with that of low viral load group(P<0.01).The LSM and FIB-4 index of HBVDNA in high and medium viral load group were compared with those in low viral load group,respectively,with statistical significance(P<0.05).There was statistical significance in gender,age,ALT,AST,PLT,HBVDNA,APRI score,FIB-4 index between the hepatic fibrosis group and the non-hepatic fibrosis group,respectively(P<0.05).The APRI score was positively correlated with LSM(r=0.430,P<0.001).FIB-4 was positively correlated with LSM(r=0.464,P<0.001).Conclusion Patients with normal ALT and HBeAg-negative chronic HBV infection are prone to liver fibrosis,and the risk of liver fibrosis is higher in men,older people,and those with high HBVDNA levels.APRI score and FIB-4 index are positively correlated with LSM.

关 键 词：乙型肝炎病毒 肝纤维化 肝脏硬度值测定 无创评估 

分 类 号：R512.62[医药卫生—内科学]