阿德福韦对HBeAg阴性慢性乙型肝炎肝组织学改变的影响

Liver histological changes after adefovir treating in chronic hepatitis B patients with HBeAg negative

目的观察阿德福韦治疗HBeAg阴性慢性乙型肝炎患者1年后肝组织学改变。方法30例HBeAg阴性慢性乙型肝炎患者口服阿德福韦酯10mg，每日1次，服药1年以上，在治疗前、治疗1年后均接受肝穿刺活检。按照Kondell组织学活动指数（HAI）评价肝组织学改变，免疫组织化学法检测肝细胞内HB—sAg、HBeAg。结果治疗1年后18例患者肝组织学改善（治疗后HAI积分下降≥2），其中17例患者坏死炎性反应程度改善（治疗后积分下降≥2），11例患者纤维化程度改善（治疗后积分下降≥1）。9例患者服药已2年以上，治疗2年时肝病理结果较治疗1年时改善更明显。免疫组织化学法检测显示治疗后肝组织内HBeAg表达明显减少，而HBsAg的表达无显著性改变。结论阿德福韦治疗HBeAg阴性慢性乙型肝炎1年后肝组织学的坏死炎性反应和肝纤维化程度均获明显改善，延长疗程可获得更显著的组织学改善。

Objective To investigate hepatic pathohistological changes（including pathology, HBV markers in liver tissue） in patients with HBeAg negative chronic hepatitis B after adefovir therapy for 1 year. Methods 35 patients with HBeAg negative chronic hepatitis B were administered with 10mg adefovir once a day for one year. The needle biopsy of liver were performed before and after treatment. The routine HE stained liver tissue sections were evaluated and Knodell pathological score were done. HBsAg and HBeAg in liver tissue were examined by immunohisochemisty method. Results After 1 year, 18,17 and 11 cases had a significant reduction of their total hepatic HAl score, necroinflammation and fibrosis score. The immunohistochemistry examination showed HBeAg in liver decreased significantly, but HBsAg had no obvious alteration. Conclusion Significant improvement in both necroinflammation and fibrosis can be obtained in the majority of patients treated with adefovir for 1 year. More significant improvement in live histology can be obtained after extended treatment.