138例ALT正常慢性乙型肝炎病毒感染者临床分析

A clinical analysis of 138 cases of chronic HBV carriers with normal ALT level

目的了解丙氨酸氨基转移酶(ALT)正常慢性乙型肝炎病毒(HBV)感染者肝脏组织学改变,分析其与性别、年龄、肝脏生化指标的关系。方法采用回顾性分析方法,收集138例ALT正常慢性HBV感染者,所有患者均行肝穿刺组织活检,同时检测肝脏生化指标。结果 138例患者中,仅5.1%的患者肝组织病理学检查完全正常,31.9%的患者肝脏炎症≥G2和(或)纤维化≥S2。不同性别、年龄之间炎症分级、纤维化分期差异无统计学意义(P>0.05)。肝脏炎症≥G2组,血清AST水平较<G2组增加(P<0.05);肝脏纤维化≥S2组血清AST、GGT水平较<S2组增加(P<0.05)。结论绝大部分ALT正常慢性HBV感染者肝组织内仍有不同程度的病理改变;不同性别、年龄的患者之间肝组织炎症分级、纤维化分期无明显差异。对于ALT正常慢性乙型肝炎病毒感染者,常规肝脏生化指标判断肝脏组织病变存在局限。

Objective To study the liver pathological changes of chronic HBV cariers with normal alanine amin- otransferase （ALT） level and its correlation to age, sex and serum biochemical markers. Methods Retrospective anal- ysis was used for 138 cases of chronic HBV cariers with normal ALT level. Liver puncture for histopathologic examina- tions were performed in all patients, and serum biochemical markers were determined by automatic biochemical analy- zer. Results Among all cases, there were only 5. 1% cases with invisibly pathological lesions of hepatic tissue, 31.9% cases with significant inflammation or fibrosis （ ≥ G2 or ≥ S2）. There was no statistical difference among differ- ent sex or age groups （P 〉 0.05 ）. The serum AST level in patients with inflammation grade ~ G2 was higher than that in with 〈 G2 and the serum AST and GGT levels in patients with liver fibrosis stage ≥S2 were higher than those in with 〈 S2 （P 〈0.05）. Conclusion This study suggest that most chronic HBV cariers with normal ALT level have different degrees of inflammation and fibrosis in liver tissue. No significant difference exist between different sex or age groups. For chronic HBV carriers with normal ALT level, there has a considerable limitation to judge liver inflammation and fi- brosis, according to serum biochemical markers.