乙型肝炎病毒携带者的肝组织病理与临床分析

Hepatic histopathological changes and clinical analysis of asymptomatic HBV carriers

目的:探讨乙型肝炎病毒携带者的肝组织病理与临床。方法:对420例临床确诊为乙型肝炎病毒携带者的患者,行肝穿病理检测,评判肝组织炎症活动度及纤维化程度,同时检测丙氨酸氨基转移酶、乙型肝炎病毒标志物及HBV-DNA。结果:年龄小于45岁者,以HBeAg阳性为主;而年龄大于45岁者,以抗-HBe阳性为主;HBeAg阳性组,HBV-DNA病毒载量显著高于抗-HBe阳性组,420例慢性无症状乙型肝炎病毒携带者中,205例肝组织学诊断正常(48.8%);215例有慢性肝病(51.2%);其中G1S0 158例、G2S1 42例、G3S1 11例、G4S4 4例;伴有肝细胞脂肪变14例。结论:慢性无症状乙型肝炎病毒携带者并非都不存在进展性肝损害,对于慢性乙型肝炎病毒感染者,年龄大于45岁,除动态观察肝功能、乙肝病毒标志物、HBV-DNA外,应动员患者行肝穿病理检测,及早发现肝组织活动性病变,甚至肝硬化的可能。

Objective：To investigate the histopathological and clinical features of asymptomatic HBV carriers.Methods：420 patients with asymptomatic HBV carrier were performed the liver puncture pathological detection for evaluating the inflammatory activity and fibrosis degree of liver tissue.At the same time, alanine aminotransferase（ALT）, HBV markers and HBV DNA were detected.Results：Positive HBeAg was mainly in the cases aged less than 45 years,positive anti-HBe was mainly in the cases aged more than 45 years.HBV DNA virus loads in the HBeAg group were significantly higher than those in the positive anti-HBe group. Among 420 asymptomatic HBV carriers,only 205 cases（48.8%） had normal liver histological diagnosis, while 215 cases （51.2%） had chronic liver diseases.Of these 215 cases, 158 cases were inflammation grade 1 fibrosis stage 0 （GISO）,42 cases Were grade 2 stage 1 （G2S1）, 11 cases were grade 3 stage 1 （G3S1）,4 cases were grade 4 stage 4 （G4S4） and 14 cases were steatosis change.Conclusion：Asymptomatic HBV carriers are not regarded as having no progressive liver lesion. Except dynamic observing liver function,HBV markers and HBV DNA,the chronic HBV carriers aged over 45 years should be mobilized to perform liver biopsy for early finding hepatic histological changes and even liver cirrhosis.