79例ALT正常慢性乙型肝炎合并脂肪肝患者的肝脏病理特点及其影响因素

Pathological characteristics and influencing factors of 79 patients of chronic hepatitis B with nonalcoholic fatty liver disease and nomal serum ALT

目的了解ALT正常的慢性乙型肝炎合并脂肪肝患者的肝脏病理特征及相关影响因素。方法分析79例血清ALT正常且HBsAg阳性合并脂肪肝患者的肝组织病理情况,分析其损害程度与年龄、HBeAg状态、HBVDNA载量及脂肪肝程度的相关性。结果 79例患者中无或轻度组织学改变(G0～G1或S0～S1)者35例(44.3%),有显著组织学改变(≥G2或≥S2)者44例(55.7%)。年龄≥40岁、HBeAg阴性、低病毒载量患者的组织学改变较重,P<0.05或P<0.01,而轻度与中重度脂肪肝患者的肝脏病理改变无统计学差异。结论 ALT正常的慢性乙型肝炎合并脂肪肝患者可能存在较大比例的肝组织损害,其肝组织损害程度与年龄、HBeAg状态及HBVDNA载量有关,而与脂肪肝程度无显著相关性。

Objective To study the pathological characteristics and its influencing factors of chronic hepatitis B patients with nonalcoholic fatty liver disease（NAFLD） and nomal serum ALT.Methods The histological characteristics of 79 patients with HBsAg seropositive and normal serum ALT and NAFLD were detected,and the relationships beween pathological changes and age,HBeAg stage,HBV DNA level and the degree of fatty change were analyzed.Results Total of 44.3% patients occurred mild pathological changes,55.7% occurred significant histological changes.Serious pathological changes often occurred in patients with older age（≥ 40 years old）,HBeAg seronegative and lower viral load（P 0.05 or 0.01）,while there was no statistical difference between pathological changes and the degree of fatty changes.Conclusions Significant pathological change is commom in patients of chronic hepatitis B with NAFLD and nomal serum ALT.The degree of pathological changes are correlated to age,HBeAg status and serum level of HBV DNA,but not correlated to the degree of fatty change.