220例慢性乙型肝炎病毒携带者5年随访分析

Five years follow-up of 220 chronic HBV carriers

目的了解慢性乙型肝炎病毒携带者的肝组织病理改变，乙型肝炎再激活率及血清学变化。方法对无锡地区220例慢性乙型肝炎病毒携带者进行了为期5年的临床症状、肝功能、肝脏组织病理学、病毒学及血清病毒标志物等的动态观察研究。结果5年间，220例中有35例出现乙型肝炎再激活，占15．9％（35／220）。220例中肝脏组织有明显炎症者（≥G2），乙型肝炎再激活率为27．0％（33／122），而肝组织炎症为G0～G1者再激活率为2．0％（2／98），肝脏组织炎症≥G2者再激活率明显高于G0～G1者，两者比较，Χ^2=25．41，P〈0．01，差异有统计学意义。35例乙型肝炎再激活患者中≥40岁者27例（77．1％），显示年龄与乙型肝炎病毒携带者再激活率有明显相关性（Χ^2=6．72，P〈0．01），而性别与再激活率无相关性。抗HBe阳性组患者，肝组织炎症程度重于HBeAg阳性组患者，Χ^2=8．68，P〈0．01，差异有统计学意义；抗HBe阳性组患者肝组织纤维化程度重于HBeAg阳性组患者，Χ^2=6．84，P〈0．01，差异有统计学意义。按年龄分组，〈40岁组及≥40岁组，两组间炎症活动度比较，Χ^2=0．62，P〉0．05，差异无统计学意义；两组纤维化程度轻（S0～1）重（≥S2）比较，Χ^2=7．37，P〈0．01，差异有统计学意义，≥40岁组纤维化程度明显重于〈40岁组。56例行2次肝活组织检查，23例行3次肝活组织检查，第一次肝活组织检查肝组织正常者几年内相对稳定，病理变化很少，原炎症程度较重者不易恢复，但可以在小范围内波动。17例HBsAg转阴，年转阴率为1．55％。其中168例HBeAg阳性者中45例发生HBeAg血清学转换，HBeAg年阴转率为5．4％。结论55％慢性乙型肝炎病毒携带者肝脏组织有明显异常（炎症≥G2），乙型肝炎再激活率与肝脏炎症分级及年龄密切相关。

Objectives To understand the hepatic pathology, hepatitis B reactivation rates and serological changes in chronic HBV carriers. Methods A 5 year dynamic observation and survey of 220 chronic HBV carriers in Wuxi district was taken, analyzing their clinical symptoms, liver histopathology, virology and HBV immunological markers. Results Thirty-five of the 220 （15.9%） patients, showed hepatitis B reactivation. The hepatitis B reactivation rate of patients with obvious hepatic tissue inflammation （≥ G2） was 27.0% （33/122） and the rate of the patients with mild hepatic tissue inflammation （G0-G1） was 2.0% （2/98）, showing significant differences （ Χ^2 = 25.41, P 〈 0.01）. The reactivation rate of patients with high inflammation was clearly higher than those with mild inflammation. Twenty-seven of the 35 hepatitis B reactivation cases were older than 40 years, showing a significant association between the ages of the patients and hepatitis B reactivation rates （ Χ^2 = 6.72, P 〈 0.01）, moreover there was no relationship between sex and the hepatitis B reactivation rate. There were differences in the inflammation grades and fibrosis stages between HBeAg positive and anti-HBe positive group cases （Kruskal-Wallis Test, Χ^2 = 8.68, P 〈 0.01, Χ^2 = 6.84, P 〈 0.01）, showing inflammation grades and fibrosis stages of the anti-HBe positive group were higher than those of the HBeAg positive group. There were no obvious differences about the inflammation grade between age 〈 40 years old and ≥40 years old group cases （ Χ^2 = 0.62, P 〉 0.05）, but there were significant statistical differences about the fibrosis stage （Χ^2 = 7.37, P 〈 0.01）, showing fibrosis stage of≥ 40 years old group cases was clearly higher than the 〈 40 years old group cases. Fitly-six cases received a liver biopsy for a second time and 23 for a third time. We found those whose hepatic tissues were normal in their first liver biopsies, then their liver histology continued remaining stable for several years while those with abnormal ones hardly or only recovered slightly. The rate of HBsAg turning to negativity per year was 1.55% and for HBeAg was 5.4%. Conclusion The hepatic tissue pathology for most chronic HBV carriers （55%） had significant abnormalities （inflammation grade ≥ G2）, and the rates of hepatitis B reactivation were highly relevant to the liver inflammation grades and the ages of the patients.