经病理诊断的慢性乙型肝炎病毒携带者与慢性肝炎的临床分析

Clinical analysis of chronic hepatitis B virus carriers and chronic hepatitis B diagnosed through pathology

目的比较病理学诊断为慢性HBV携带者与慢性肝炎患者的临床资料，为不同ALT水平的慢性HBV感染者的处理提供病理学依据。方法对292例慢性HBV感染者进行肝活组织检查，按病理学诊断符合慢性HBV携带者标准（GO-G1且SO-S1）与慢性肝炎标准[G〉1和（或）S〉1]分为携带组和肝炎组，比较不同年龄分层及ALT水平分层与病理诊断的关系，同时比较其他可能与病理诊断相关的临床、生物化学及影像学指标，Logistic回归方程（后退法，极大似然法）进行多因素分析，确定病理学符合慢性HBV携带者诊断的独立影响因素。结果292例患者中，病理诊断为慢性HBV携带者有140例，占47．9％；慢性肝炎152例，占52．1％。HBV携带组与慢性肝炎组在≤35岁与36-40岁、〉40岁比较，差异有统计学意义（X^2=3．936，8．534；P-0．047，0．003）；ALT水平在〈O．5×正常值上限（ULN）、（0．5-1．O）×ULN、（1．1-1．5）×ULN、（1．6-2．0）×ULN、〉2．0×ULN间比较差异有统计学意义（X^2=55．314，P〈O．01），但ALT在（1．1-1．5）×ULN与〉2．0×ULN比较，差异无统计学意义（X^2=3．810，P=0．051）。多因素分析显示，病程、饮酒史、ALT分层、HBVDNA水平及超声检查肝表面是否光滑是病理学符合慢性HBV携带者诊断的独立影响因素（0R-0．995、0．224、0．516、1.308、0.270，P-0．005、0．007、0．000、0．025、0．001）。结论年龄35岁以上且ALT水平介于（1-2）×ULN的患者行肝活组织检查的临床意义更大。

Objective To compare the clinical data of patients with chronic hepatitis B virus （HBV） carriers and chronic hepatitis B so that to provide pathological evidence for management of chronic HBV carriers with different alanine aminotransferase （ALT） levels. Methods Liver biopsies were performed in totally of 292 cases of chronic HBV infection. The subjects were divided into HBV carrier group （G0-G1 and S0-S1） and hepatitis group （G〉 1 and/or S〉 1） according to thepathological diagnosis. The relationships between different age subgroups, different ALT level subgroups and pathological diagnosis were analyzed. Meanwhile, other clinical, biochemical, and iconographie indexes which were possibly related to the pathology diagnosis were compared. The multivariate analysis was done by Logistic regression equation （withdrawal method, maximum likelihood method） to definite the independent influencing factors of pathologically diagnosed withchronic HBV carrier. Results Among the 292 patients, 140 （47.9%） were pathologically diagnosed with chronic HBV carries and 152 （52. 1%） were chronic hepatitis B. There were statistical differences between 435 years group and 36-40 years, 〉40 years group （X^2 =3. 936 and 8. 534,respectively; P = 0. 047 and 0. 003, respectively）. There were statistical difference among patients withALT〈0.5Xupper limit normal （ULN）, （0. 5-1. 0） ）〈 ULN, （1.1-1.5））〈ULN, （1.6 -2.0） XULN and 〉2.0 X ULN （X^2 = 55. 314, P〉0. 01）, while there was no significant difference between （1. 1-1. 5）×ULN and 〉2. 0×ULN X^2=3. 810, P=0. 051）. Multivariate analysis indicated that course of disease, alcohol consumption, ALT, HBV DNA level and the surface of liver （smooth or not smooth） detected by ultrasonography were independent influencing factors of pathological diagnosis of chronic HBV carriers （OR =0. 995, 0. 224, 0. 516, 1. 308 and 0. 270, respectively; P=0. 005, 0. 007, 0. 000, 0. 025 and 0. 001, respectively）. Conclusion laver biopsy is much meaningful in patients with age 〉35 years old and ALT （1-2）XULN.