肝穿刺病理学检查对肝功能正常HBV感染者诊断的临床意义

Diagnostic Value of Liver Biopsy in Patients with Normal Liver Function Infected with Chronic Hepatitis B Virus

目的评估肝穿刺组织病理学检查对肝功能正常的慢性乙型肝炎病毒(HBV)感染者的诊断价值。方法选取肝功能正常的慢性HBV感染者244例,行肝穿刺病理检查,同时检测肝功能、血清HBV DNA及HBV血清学标志物。结果 244例患者中符合病毒携带者53例(21.7%);慢性乙型肝炎轻度143例(58.6%),中度34例(13.9%),重度14例(5.7%),肝硬化7例(2.9%)。炎症分级G≥2者48例(19.7%);纤维化分期S≥2者54例(22.1%)。HBeAg阴性组患者中如HBV DNA高水平复制,其病理炎症分级及纤维化分期均明显重于阳性组(P<0.05)。HBV DNA高载量和低载量(以105拷贝/毫升为界限)肝组织炎症分级统计学差异无显著意义,但是纤维化分期则差异明显。结论多数肝功能正常的慢性HBV感染者有一定程度的病变损害,血清HBeAg及HBV DNA均不能完全反映肝脏病变情况,肝穿刺组织病理学检查在判定肝功能正常的HBV感染者的病情程度和指导治疗方面有重要价值。

Objective To evaluate diagnostic value of liver biopsy in patients with normal liver function infected with chronic hepati- tis B virus（ HBV）. Methods 244 patients with normal liver function infected with HBV were examined with liver biopsy,liver function, HBV DNA level and serological markers of hepatitis B e antigen（HBeAg）. All patients were divided into different groups based on serum HBeAg and HBV DNA levels. Results From liver histopathology,53 cases （21.7%） was diagnosed with chronic hepatitis B virus carrier,143 cases （58.6%） with slight chronic hepatitis B（CHB） ,34 cases （13.9%） with moderate CHB and 14 cases （5.7%） with severe CHB,in which 7 cases （2.9%）were diagnosed with cirrhosis. 48 cases （19.7%）had inflammation grades with G≥ 2, and 54 cases （22. 1% ）had fibrosis stages with S ≥2. The inflammation grades and fibrosis stages in patients with HBeAg negative and high levels of HBVDNA replication were more severe than HBeAg positive group （ P 〈 0.05 ）. No significant differences were observed in the inflammation grades between HBV DNA high group（ 〈 10^5 copies/ml） and low group （ 〈 10^5 copies/ml） , however fibrosis stages were significantly differ- ent between the two groups. Conclusion Most patients with normal liver function infected with HBV have mild inflammatory histological changes and （or） different degrees of liver fibrosis. Serum HBeAg and HBV DNA are unable to reflect the real condition of lives injury. Liver biopsy is more valuable to evaluate the disease severity of asymptomatic chronic HBV carriers and to determine treating plan.