慢性HBV感染ALT持续正常与肝损伤的关系及其相关因素分析

Association between persistent normal ALT with chronic hepatitis B and liver injure as well as analysis of correlated factors

目的评估ALT持续正常的慢性HBV感染者(PNA)的肝脏损伤情况,探讨与其损伤相关的因素,为临床正确及时处理此类患者提供参考。方法对符合研究标准的160名慢乙肝患者,包括血清ALT水平持续正常的53例患者,按ALT水平分成4组,检测相关生化免疫等指标,同时做肝病理穿刺,分析与肝损伤相关的因素。结果37.7%的PNA患者有S2及以上等级的纤维化,45.3%的PNA患者有G2及以上等级的炎症水平。年龄越大,ALT水平越高,更高水平的HBVDNA载量,有更严重的肝损伤。结论53例PNA患者中,43.4%有明显纤维化或明显炎症,对于PNA的慢乙肝患者,大于40岁、ALT>25u/L、HBVDNA定量>104/mL,尤其是男性患者,应考虑肝穿刺以证实是否有肝损伤。

Purpose To assess liver injury of these patients with chronic hepatitis B whose ALT are persistently normal, to explore these factors associated with liver injury, and to provide choices when clinicians are treating those patients. Methods 160 patients meeting our inclusion criteria were divided into four groups ac- cording to their ALT. Multiply clinical, biochemical, immunological, virological indexes were collected, meanwhile, liver biopsy was performed. Results 43.4 % of patients with PNA have significant inflammation and 17.1% has significant fibrosis. Older age, higher ALT and HBV DNA load predicted liver injury. Conclusion In our studies, 45.3 % of patients with PNA were associated with severe inflammation or fibrosis. We can make a conclusion that liver biopsy should be performed in those patients whose age 〉 40 y, ALT 〉 25 u/ L, HBV DNA 〉 10^4 to confirm whether hepatic injury exists.