免疫耐受期和非活动复制期乙型肝炎病毒感染者的肝脏病理与临床特征

Liver pathological changes and clinical features of patients with chronic hepatitis B virus infection in their immune tolerant phase and non-active status

目的了解免疫耐受期和非活动复制期HBV感染者的肝脏病理与临床特征,以及它们的区别。方法分析和比较54例免疫耐受期和47例非活动复制期HBV感染者年龄、性别、血清HBV DNA水平、肝脏炎症活动度及纤维化程度、肝脏HBsAg和HBcAg表达情况。并对不同血清ALT水平的肝脏炎症活动度及纤维化程度进行比较。结果两组患者性别构成比无明显差异,但非活动复制期HBV感染者年龄明显高于免疫耐受期[分别为（28．11±8．60）和（24．93±7．21）岁, P〈0．05]。免疫耐受期患者血清HBV DNA水平较高,106拷贝／ml以上者占94％,而89％的非活动复制期患者血清HBV DNA为阴性,其余患者表现为低水平复制。两组患者肝脏炎症活动度、HBsAg和HBcAg的表达无明显差异,但非活动复制期患者纤维化程度明显高于免疫耐受期（u=2．004, P〈0．05）。血清ALT在正常范围内较高水平患者的肝脏纤维化程度明显高于低水平患者（u=3.274, P〈0．01）。结论非活动复制期HBV感染者可能经历多次隐匿的免疫清除过程,因此年龄较大、纤维化程度较高。ALT持续处于正常范围内的较高水平患者可能纤维化程度较重,建议行肝脏病理学检查。

Objective To investigate the liver pathological changes and the clinical features of patients with hepatitis B virus （HBV） infection in their immune tolerant phase and non-active status. Methods Fifty-four patients with chronic HBV infection in their immune tolerant stage and another 47 patients with the same infection but in non-active status were involved in this study. Statistical analysis including the ages and sex of the patients, their serum levels of HBV DNA, hepatocytic expression of HBsAg and HBcAg and their liver pathology were studied and statistically analyzed. Histological grading of inflammation and staging of fibrosis in the livers were also compared and analysed in patients with different levels of serum ALT. Results The sex ratio of the two groups was of no significant difference. The average age of the patients in the non-active status [（28.11±8.60） years.] was older than that of the patients in the immune tolerant stage [（24.93 ±7.21） years], showing a significant difference （P 〈 0.05）. The serum levels of HBV DNA of the patients in the immune tolerant stage were high and 94% of them had a HBV DNA higher than 10^6 copies/ ml. In the non-active status group, 89% of the patients were HBV DNA negative. Between the two groups of patients there were no significant differences in the histological grades of liver inflammation or in the hepatocytic expressions of HBsAg and HBcAg. The stage of fibrosis was higher in the non-active status group than in the immune tolerant stage group, showing a significant difference between these two groups （u = 2.004, P 〈 0.05）. The fibrosis stages of the livers of patients of a higher but within normal ALT level were markedly higher than those of a lower but within normal ALT level patients （u = 3.274, P 〈 0.01）. Conclusion Patients infected with HBV in non-active status may have experienced some occult courses of immune active stages; they are older in age and have higher levels of fibrosis. ALT sustained at a high level but within the normal range may indicate a higher degree of fibrosis, therefore liver pathological studies should be recommended for this kind of patient.