慢性丙型肝炎患者血清HCV RNA,ALT与肝脏病理间的关系

Correlations of serum hepatitis C virus RNA and alanine transaminase with liver histopathological changes in patients with chronic hepatitis C

目的:探讨慢性丙型肝炎患者血清HCV-RNA 水平、ALT浓度及肝组织病理改变三者之间的关系．方法:采用荧光定量聚合酶链反应(FQ-PCR) 检测132例慢性丙型肝炎患者血清中HCV RNA的水平,用生化自动分析仪检测ALT值, 其中30例患者进行了肝脏活检,用HE染色,光学显微镜下观察肝脏病理改变．结果:在132例慢性丙型肝炎患者中有98例 HCV RNA水平超过1．0×106拷贝／L,阳性率为74．2％,有99例ALT水平超过正常值,异常率为75．0％．HCV-RNA水平与ALT浓度相关性不显著(r=0．40,P=0．695),与ALT异常率呈明显相关(r=1．00,P<0．01)．肝穿病理结果表明, HCV-RNA水平与肝脏的炎症活动度和纤维化程度均不相关(r=0．50,P=0．667;r=0．20,P= 0．80)．ALT浓度与肝脏的纤维化程度不相关(r =0．40,P=0．60),而与肝脏的炎症活动度呈明显相关(r=1．00,P<0．01)．结论:慢性丙型肝炎患者血清HCV RNA水平与ALT浓度无关,也不能反映肝组织病理损伤程度;ALT浓度与肝脏的纤维化程度无关,但可在一定程度上反映肝脏的炎症改变．

AIM： To investigate the relationship among serum hepatitis C virus RNA titer, alanine transaminase （ALT） and liver histological changes in patients with chronic hepatitis C. METHODS： Fluorescent quantitative polymerase chain reaction was used to detect the level of serum HCV RNA in 132 patients with chronic hepatitis C; meanwhile, the levels of serum ALT were measured by biochemical instrument. Liver biopsy was performed in 30 of 132 patients, and histopathological changes were observed by HE staining under light microscope and scored according to the grades of liver necro-inflammatory activity and stages of liver fibrosis. RESULTS： Of 132 cases, 98 （74.2%） were positive for HCV RNA （over 1.0×10^6 copies/L）, and 99 （75.0%） were with a higher ALT level. No significant correlation was noted between HCV RNA titer and ALT level （r = 0.40, P = 0.695）, but a statistical relationship was noted between HCV RNA titer and the abnormal rate of ALT level （r = 1.00, P 〈 0.01）. Liver biopsies indicated that HCV-RNA titer was not significantly correlated with the grades of liver necro-inflammatory activity （r = 0.50, P = 0.667） or the stage of liver fibrosis （r = 0.20, P = 0.80）. The level of serum ALT was not markedly correlated with the stages of liver fibrosis （r = 0.40, P = 0.60）, either, but statistically correlated with the grades of liver necro-inflammatory activity （r = 1.00, P 〈 0.01）. CONCLUSION： HCV RNA titer has no correla- tion with ALT level, and it can not reflect the degree of liver histological damage in patients with chronic hepatitis C. ALT level has no correlation with the stages of liver fibrosis, but it can reflect the grades of liver necro-inflammatory activity to some extent.