肝功能正常的乙型肝炎病毒感染者临床病理分析

Clinical and pathological analysis of hepatitis B virus carriers with normal aminotransferase level

目的了解肝功能正常的乙型肝炎病毒感染者的临床病理特点。方法对294例患者进行生化、病毒标志物及病毒定量检测,并结合肝脏病理组织学检查进行分析。结果光镜下见肝组织基本正常者10例,病理诊断为轻度肝炎者220例,肝硬化22例,其中活动期肝硬化16例,静止期肝硬化2例,未明确4例。在所有患者中炎症分级≥2者计116例,占总数的42.6%(116/272)。血清HBV DNA水平与肝组织炎症分级间无明显相关性,而HBV DNA阴性组肝纤维化程度要重于HBV DNA阳性组;HBeAg阴性组肝组织炎症程度及纤维化程度均要重于HBeAg阳性组。WBC、PLT、GGT、CHE和γ球蛋白5个指标对于肝硬化的诊断具有辅助价值。结论对于肝功能正常的乙型肝炎病毒感染者应尽可能行肝脏病理检查,以明确诊断,并指导治疗。

Objective To explore clinical pathological characteristics of hepatitis B virus carriers with normal aminotransferase level. Methods Biochemical indices, virus marker and viral load were detected in 294 cases of hepatitis B virus carriers with normal aminotransferase level, and the correlation with pathological grading and staging was analysed. Results The fiver tissues of only 10 cases were basically normal under microscope, 220 cases in mild damage were diagnosed by pathology, and 22 cases had fiver cirrhosis, among which 16 cases were active, 2 inactive and 4 undetermined. Among all the patients, 116 patients （42.6%） were in inflammation grade 2 or higher. HBV DNA level had no correlation with liver inflammation activity, however, liver necroinflammation grading and fibrosis staging in hepatitis B e antigen （HBeAg）--negative group and HBV DNA negative group were more advanced than those in HBeAg-positive group and HBV DNA positive group, respectively. White blood cell, platelet, γ -glutamyltransferase, chofinesterase and globulin γ had some significance in the diagnosis of liver cirrhosis. Conclusion Liver biopsy and pathological examination should be made in hepatitis B virus carriers with normal aminotransferase level, so that antiviral therapy can be carried out in HBeAg-negative and HBV DNA positive hepatitis B patients.