HBeAg阳性慢性乙型肝炎肝活检患者病情进展危险因素分析

Analysis of risk factors about disease progression in patients with HBeAg-positive chronic hepatitis B receiving liver biopsy

目的了解HBeAg阳性慢性乙型肝炎患者年龄、性别、HBVDNA载量、乙肝家族史等因素不同水平之间炎症纤维化程度的构成差异。方法回顾性分析了我院2年来行肝活检的179例HBeAg阳性慢性乙型肝炎患者资料,对上述因素进行分层分析。结果多数患者30岁以前即开始进入免疫清除期,中重度纤维化多见于40岁以上;男女发病人数比值约为3.5:1,男性G≥2的患者比例明显高于女性,但男女之间纤维化构成比无差别;HBVDNA处于104～106copies/ml水平时,中重度炎症(G≥2,76.5%)最为显著,HBVDNA<104copies/ml的患者中重度纤维化比例(S≥2,62.5%)最高。有家族史的患者约占40%,较无家族史者G≥2比例更高(71.2%vs.61%),但纤维化程度方面无差别。结论HBeAg阳性患者年龄、性别、HBVDNA水平、乙肝家族史等因素不同水平间炎症纤维化程度存在构成比差异,对<40岁、女性、HBVDNA<104copies/ml及无乙肝家族史的患者,也要给予足够重视。

Objective To understand the composition differences of inflammation and fibrosis among the different parameters such as age,sex,HBV DNA load,hepatitis B family history in patients with HBeAg-positive chronic hepatitis B.Methods 179 patients with HBeAg-positive chronic hepatitis B were all from our hospital and given liver biopsy within two years.Data were retrospectively analyzed based on the stratified levels of above parameters.Results Most of patients initiating the immune clearance phase were before 30 years old.Patients with fibrosis （moderate and severe） were prevalent after 40 years old.The ratio of male to female was approximately 3.5：1.Male patients with G ≥ 2 was significantly higher than that of female,but there was no difference in composition ratio of fibrosis between men and women.Patients with HBV DNA load at 10^4～10^6copies/ml were mostly characterized by moderate to severe inflammation （G≥2,76.5%） and 62.5% patients with HBV DNA〈10^4 copies/ml were with moderate to severe fibrosis （S≥2）.About 40% of patients had family hepatitis B history.Patients with family history had higher percentage of G ≥ 2 compared to those without family history （71.2% vs 61%）,but no difference were observed in fibrosis level between these two groups.Conclusions Composition differences of inflammation and fibrosis were observed in different parameters such as age,sex,HBV DNA load,hepatitis B family history.Our data showed that patients with even before 40-year-old,female,HBVDNA 104copies/ml or without family history should also be paid attention in clinical practice.