ALT轻度升高的HBeAg阳性和阴性慢性乙型肝炎患者肝组织病理学特点

Characterisctic of liver pathology in HBeAg-positive and HBeAg-negative chronic hepatitis B patients with mildly elevated ALT

目的分析ALIT轻度升高（1～2倍正常值上限）的HBeAg阳性和阴性慢性乙型肝炎患者肝组织病理学特点，并探讨年龄及HBVDNA水平对其的影响。方法收集2009年10月至2011年3月，“十一五”国家科技重大专项——慢性乙型肝炎中西医结合治疗方案入组病例中符合条件者，行B超引导下肝穿刺活组织检查，并检测HBsAg、HBeAg滴度及HBVDNA水平。比较HBeAg阳性和阴性患者炎症分级和纤维化分期情况及年龄（≥40岁和〈40岁）、HBVDNA水平（≥10^5拷贝／ml和〈10^5拷贝／m1）对其的影响。两样本构成比的比较用χ2检验，相关性分析用多因素logistic回归分析。结果389例HBeAg阳性与126例HBeAg阴性患者的肝组织炎症分级与纤维化分期分布差异均无统计学意义（χ2值分别为4．326和3．464，P值均〉0．05）。〈40岁组中，HBeAg阳性与阴性患者的炎症分级及纤维化分期分布差异无统计学意义（χ2值分别2．543和5．024，P值均〉0．05）。≥40岁组中，HBeAg阳性患者中、重度炎症（G3、G4）所占百分比（32．9％）明显高于HBeAg阴性者（16．4％），χ2=8．777，Jp〈0．05；纤维化分期分布差异无统计学意义（χ2=0．977，P〉0．05）。HBVDNA≥10’拷贝／ml患者中，HBeAg阳性患者轻度炎症（G1）所占百分比（17．5％）明显高于HBeAg阴性患者（7．3％），χ2=8．851，P〈0．05；HBeAg阳性和阴性患者肝组织纤维化分期分布差异无统计学意义（χ2=8．227，P〉0．05）。HBVDNA〈10^5拷贝／ml的患者中，HBeAg阴性患者轻度炎症（G1）所占百分比（29．6％）明显高于HBeAg阳性患者（6．9％），χ2=6．357，P〈0．05；HBeAg阳性和阴性患者肝组织纤维化分期分布差异无统计学意义（χ2=4．061，P〉0．05）。多因素Logistic回归分析结果显示，年龄是肝脏病理炎症和纤维化轻重程度的独立危险因素（OR值分别为1．92和2．11，P值均〈0．05）。结论ALT轻度升高慢性乙型肝炎患者中，HBeAg状态与肝脏病理炎症及纤维化程度无关。年龄≥40岁的HBeAg阳性患者中、重度炎症比例明显升高;不同HBVDNA水平的HBeAg阳性与阴性患者肝脏炎症分级也有差异。

Objective To alalyse the live pathology characteristics in mild ALT-elevated （1 × ULN ≤ALT ≤2 × ULN ） HBeAg-positive and HBeAg-negative chronic hepatitis B （CHB） patients, and to explore the influence of the age and HBV DNA level to liver pathology in different HBeAg status patients. Methods All the patients who met the inclusion criteria form ＂eleventh five-year plan＂ National Science and Technology Major Project, the treatment program of integrative traditional and western medicine for CHB were enrolled in this study between October 2009 and March 2011 .B type ultrasound-guided liver biopsy was carried out in all patients and hepatitis B surface antigen （HBsAg）, HBeAg titer as well as HBV DNA level were detected at the same time. Hepatic tissue inflammation and fibrosis degree of patients according to HBeAg- positive and negative, age （≥ 40 years and 〈 40 years）, HBV DNA level （≥ 105copy/ml and 〈 105 copy/ml） were compared respectively. Chi-square test was used to compare the constitute percentage between the two samples. Multivariate logistic regression analysis was also performed to evaluate the correlation between different factors. Results There were no significant difference in the grade of liver inflammation and the stage of liver fibrosis between 389 HBeAg positive and 126 HBeAg-negative patients（χ2= 4.326 andz2 = 3.464, respectively, P values were all 〉 0.05）. In the group of patients with age 〈40 years, the distribution of different liver inflammation and fibrosis had no significant difference between HBeAg-positive and negative patients （ χ2 =2.543 andz2=5.024, respectively, P values were all〉0.05）. In the group of patient with age ≥ 40 years, the percentage of moderate and severe inflammation （G3, G4） HBeAg-positive patients（32.9%） owned is much higher than that of HBeAg-negative patients（16.4%）, χ2 = 8.777, P〈 0.05.But the stage of liver fibrosis in HBeAg-positive patients was not significantly different than that of HBeAg-negative ones （χ2 = 0.977, P〉 0.5）. In the group of patients with HBV DNA≥ 105copy/ml, the percentage of mild inflammation in HBeAg- positive patients （17.5%） was much high than that of HBeAg-negative patients（7.3%）,χ2 = 8.851,P〈 0.05. The stage of liver fibrosis between HBeAg-positive and negative patients was no significant difference（χ2 = 8.227, P〉 0.05）.In the patients with HBV DNA 〈105 copy/ml, The percentage of HBeAg-negative patients（29.6%） with mild inflammation（G1） was much higher than HBeAg-positve patients（6.9%）,χ2 = 6.357, P〈 0.05. There was no significant difference in the stage of liver fibrosis between HBeAg-positve and negative patients（χ2 =4.061, P〉 0.05）. The results of multivariate logistic regression analysis showed that age was the independent risk factor for different degree of liver inflammation and fibrosis seriousness. Conclusion The status of HBeAg has no association with the grade of liver inflammation and the stage of liver fibrosis in CHB patients with mildly elevated ALT. The percentage of moderate and severe inflammation in the HBeAg-positve patients with age ≥ 40 years was significantly elevated. The grade of liver inflammation has significant difference between HBeAg- positive and negative patients with different HBV DNA levels as well.