慢性乙型肝炎病毒携带者和ALT轻度升高慢性乙型肝炎患者的肝脏病理及临床特征

Comparison of liver pathohistological and clinical characteristics between chronic HBV carriers and chronic hepatitis B patients with mild elevation in ALT

目的分析不同ALT水平慢性HBV携带者和血清ALT轻度升高慢性乙型肝炎患者肝组织病理学及临床改变、B超检查结果的差异，寻找与肝组织学改变相关的因素。方法将128例患者分为3组：A组：ALT≤0．5×正常值上限（ULN），B组：0．5×ULN〈ALT≤1×ULN，C组：1×ULN〈ALT〈2×ULN，对比各组年龄、性别、血清HBV DNA定量、HBeAg阳性率、肝内HBcAg的表达、脾脏厚度、门静脉内径、门静脉流速、右肝最大斜径及肝脏炎症活动度、纤维化程度，并进一步分析不同肝脏病理变化时上述临床及超声检查资料的差异。多组均数比较采用方差分析，两组均数比较采用t检验，率和构成比的比较采用卡方检验。结果128例患者中，肝脏炎症G1期57例（44．5％），G2期71例（55．5％）；纤维化S1期72例（56．3％），S2期30例（23．4％），26例（20．3％）无纤维化。C组炎症病变重于A组（x^2=7．29，P〈0．05），与A、B组的脾脏厚度、右肝最大斜径差异有统计学意义（P值均〈0．01）。不同肝组织炎症分级患者，血清ALT、脾脏厚度、门静脉内径、肝内HBcAg阳性率随炎症分级的增加明显增加（P值均〈0．05）。不同肝组织纤维化分期患者，脾脏厚度、门静脉内径、右肝最大斜径、血清HBeAg阴性比率随纤维化加重明显增加（P值均〈0．05），门静脉流速随纤维化加重明显降低（P〈0．01）。结论对于ALT〈2×ULN的慢性HBV感染者，仍有55．5％的患者炎症活动度达G2，有23．4％的患者纤维化程度达S2；密切随访血清ALT、脾脏厚度、门静脉内径及流速、右肝最大斜径、肝内HBcAg的表达，对协助了解肝脏病理变化有一定的提示作用。

Objective To compare the liver pathohistological and clinical features between chronic HBV carriers and chronic hepatitis B patients with mild elevated in ALT. Methods 128 patients were divided into 3 groups according to the ALT： group A： ALT ≤ 0.5 × ULN, group B： 0.5 × ULN 〈 ALT ≤ 1 × ULN, group C： 1 × ULN 〈 ALT 〈 2 × ULN. The age, sex, serum HBV DNA, HBeAg status, expession of HBcAg in liver, thickness of spleen, breadth of portal vein ,blood stream speed of protal vein, right liver obliqua diameter, grade of liver inflammation and stage of liver fibrosis were compared in the three groups. Results Among 128 patients, 57（44.5%） patients had G1 hepatitis and 71 （55.5%） had G2 hepatitis, no G0 hepatitis was found in these patients; 72 patients （56.3%） had S1 fibrosis, 30 （23.4%） patients had S2 fibrosis, and 26 （20.3%） patients did not have liver fibrosis. The liver inflammation in group C was more aggravated than that in group A （P 〈 0.05）. And there were significant differences in thickness of spleen and fight liver obliqua diameter between group C and group A, as well as between group C and B （P all 〈 0.01）. With the aggravating of liver inflammation, the serum ALT, thickness of spleen, breadth of portal vein and expression of HBcAg in liver were increased obviously （P 〈 0.05）. With the aggravating of liver fibrosis, the thickness of spleen, breadth of portal vein, fight liver obliqua diameter and HBeAg negative patients were increased obviously, while the blood stream speed of portal vein was decreased obviously （P 〈 0.01）. Conclusion Among the chronic HBV infection patients whose ALT 〈 2 × ULN, there were 55.5% patients had G2 of liver inflammation and 23.4% patients had S2 of liver fibrosis. The serum ALT, thickness of spleen, breadth and blood stream speed of portal vein, fight liver obliqua diameter and expression of HBcAg in liver are associated with pathohistological changes in these patients.