慢性乙型肝炎患者肝功能及血清HBeAg和HBV DNA载量与肝组织病理相关性的研究

Relationships between liver function test, serum HBeAg or HBV DNA level and liver pathological changes in patients with chronic hepatitis B

目的探讨慢性乙型肝炎患者肝功能、HBeAg及HBVDNA水平与肝组织病理炎症分级和纤维化分期的关系。方法选择233例慢性乙型肝炎患者进行肝穿病理学检查，同时所有患者检测HBVDNA、HBeAg及肝功能，比较患者的肝功能、HBeAg及HBV DNA水平在不同病理炎症分级及纤维化分期中的差异情况。结果不同的炎症分级患者中，ALT以C3组最高，G0-1组最低，各组间比较差异有统计学意义（P=0．016）；TBil以G4组最高，G0-1组最低，各组间比较差异有统计学意义（P=0．000）；HBVDNA载量各组间差异无统计学意义。不同的纤维化分期患者中，ALT各组间比较差异无统计学意义；TBil以S4组最高，S2组最低，各组间比较差异有统计学意义（P=0．039）；HBVDNA载量各组间差异无统计学意义。炎症分级为G3-4的患者比例在HBeAg阳性组与阴性组差异无统计学意义。纤维化分期S3-4的患者比例在HBeAg阳性组（38％）比HBeAg阴性组（53％）低，两组差异有统计学意义（P=0．025）。结论慢性乙型肝炎患者血清HBVDNA水平的高低不能反映其肝脏炎症及纤维化程度，HBeAg阴性慢乙肝患者肝组织纤维化程度较高，TBil水平与肝组织炎症分级及纤维化分期均有良好的相关性，ALT水平与炎症分级有一定的关联性，但与纤维化分期无关。

Objective The aim of this study was to investigate the relationship between liver function test, serum HBeAg, HBV DNA level and liver pathological changes in patients with chronic hepatitis B. Methods 233 patients with chronic hepatitis B accept liver functure biopsy, liver function test, HBeAg detection and HBV DNA fluorescent quantitation PCR detection. Comparisons of liver function test, HBeAg and HBV DNA level were conducted among different liver pathological changes including inflammation grading and fibrosis staging. Results In different inflammation grading groups, ALT was highest in group G3 and lowest in group G0-1 （ P = 0.016） ;TBil was highest in group G4 and lowest in group G0-1 （ P = 0.000） ;HBV DNA level was highest in group G4 and lowest in group G0-1 , but not statistically significant among groups （P = 0.463 ）. In different fibrosis staging groups, ALT was highest in group S3 and lowest in group S0-1, but not statistically significant among groups （P=0. 562） ;TBil was highest in group S4 and lowest in group S2（P = 0.039） ;HBV DNA level was highest in group S3 and lowest in group S0-1 , but not statistically significant among groups （ P = 0. 395 ）. In HBcAg positive group, the proportion of G3-4 in inflammation grading or S3.4 in fibrosis staging was lower than that in HBeAg negative group （46% vs 52%, P = 0.438;38 % vs 53 %, P = 0.025 ;respectively）. Conclusion HBV DNA level can not indicate the severity of liver inflammation or fibrosis in chronic HBV infection. Patients with HBeAg negative often are complicated with more severity of liver fibrosis. In routine liver function test, TBil level correlates with liver inflammation grading or fibrosis staging;ALT level also correlates with liver inflammation grading but not with fibrosis staging.