慢性丙型肝炎患者肝组织学改变及其影响因素分析

Liver histological changes and influencing factors in patients with chronic hepatitis C

目的探讨慢性丙型肝炎患者肝组织学改变及其影响因素。方法选择经皮肝组织活检的慢性丙型肝炎患者102例，记录患者年龄、性别、体质指数（BMI）、感染途径等，检测ALT水平、AST水平、HCV基因分型、病毒载量和肝脏组织学改变。统计学处理采用t检验和Logistic回归分析。结果肝脏炎症活动指数（HAD≥4的慢性丙型肝炎患者的ALT、AST水平较高，PLT较低，与HAI〈4的患者相比差异有统计学意义（t=2．209、2．298、2．565，均P〈0．05）。纤维化分期评分（F）≥3的患者平均年龄、ALT水平、AST水平以及感染时间均高于F〈3的患者（t=2．340、3．497、2．758、2．570，均P〈0．05），而PLT则较低（t=2．761，P=0．007）。女性、ALT〉1×正常值上限（ULN）、AST水平、F≥3、HCVRNA≥6 lgIU／mL和PLT计数是HAI≥4的单因素预测因子；经多因素分析后，Ishak纤维化分期评分是HAI≥4的唯一独立预测因子（OR3．098，95％CI 1．884～5．092，P〈0．01）。单因素分析F≥3的预测因子为年龄、BMI≥24kg／m^2、ALT〉1×ULN、AST水平、HAI≥4、PLT计数以及感染年限≥15年；多因素回归分析显示，年龄（OR 1．074，95％CI 1．006～1．146，P=0．033）、ALT水平（OR1．035，95％CI 1．015～1.055，P〈0．01）、AST水平（OR0．969，95％CI 0．948-0．990，P=0．005）、感染年限≥15年（OR37．215，95％CI 5．816～238．1．27，P〈0．01）和HAI≥4（OR 1．939，95％C1 1．426～2．636，P〈0．01）是F≥3的独立危险因素。结论年龄、ALT水平、AST水平、感染年限≥15年和HAI≥4是肝组织学显著纤维化的独立预测因子。

Objective To investigate the histological features as well as the factors influencing liver disease progression in Chinese patients with chronic hepatitis C （CHC）. Methods A total of 102 CHC patients who underwent percutaneous liver biopsy between August 2007 and May 2010 were recruited. Age, gender, body mass index （BMI） and transmission route of recruited patients were recorded. Serum levels of alanine transaminase （ALT） and aspartate transaminase （AST）, HCV genotypes, HCV viral load and liver histological changes were detected. Statistical analysis was done by t test and Logistic regression. Results The serum levels of ALT and AST in CHC patients with histological activity index （HAD≥4 were much higher, while piatelet （PLT） counts were lower than those with HAI 〈4（t=2. 209, 2. 298 and 2. 565, respectively; all P〈0.05）. Likewise, in patients with F≥3, the serum levels of ALT and AST as well as the mean age and the duration of infection were significantly elevated compared with F 〈 3 group （t = 3. 497, 2. 758, 2. 340 and 2. 570, respectively; all P〈0. 05）, while PLT counts were much lower （t = 2. 761, P= 0. 007）. The unvariate predictors for HAI≥4 were female, ALT2〉1× upper limits of normal （ULN）, AST level, F≥3, HCV RNA≥6 lgIU/mL and PLT counts. By mutivariate analysis, the Ishak stage score was the only independent predictor for HAI≥4 （OR 3. 098, 95%CI 1. 884-5.092; P〈0.01）. Finally, the univariate predictors for F≥3 were age, BMI≥24 kg/m2, ALT〉1×ULN, AST level, HAI≥4, PLT counts and duration of infection≥15 years. Multivariate analysis revealed that age （OR 1. 074, 95%CI 1. 006-1. 146; P=0. 033）, ALT level （OR 1. 035, 95%CI 1. 015-1. 055% P〈0.01）, AST level （OR 0.969, 95%CI 0. 948-0. 990; P=0. 005）, the duration of infection≥15 years （OR 37. 215, 95% CI 5. 816-238. 127; P〈0.01） and HAI≥4 （OR 1. 939, 95% CI 1. 426-2. 636; P% 0.01） were independent predictors for F≥3. Conclusion Age, ALT level, AST level, duration of infection≥15 years, HAI≥4 are independent predictors for liver fibrosis.