ALT小于2倍正常上限的HBeAg阴性慢性HBV感染者肝脏病理改变及相关因素分析

Liver pathohistological changes and pathohistology correlated factors of HBeAg-negative chronic hepatitis B virus infectors with ALT less than two-time up limit of normal

目的探讨ALT小于2倍正常值上限（upper limits of normal，ULN）的HBeAg阴性慢性HBV感染者中与肝脏病理学改变相关的临床指标。方法将60例ALT〈2×ULN的HBeAg阴性慢性HBV感染者按照不同肝脏炎症程度及纤维化程度分组，对比各组患者性别比例、年龄、血清ALT、HBVDNA定量、脾脏厚度、门静脉内径、肝脏瞬时弹性探测仪（FibroScan）测定肝硬度值（liver stiffness measurement，LSM）的变化情况。结果60例患者肝脏炎症改变在G1～G3级，纤维化程度在S0～S2期，其中≥G2、达S2者分别为49例（81.7％）、19例（31.7％）。60例患者中，随着肝脏炎症及纤维化程度的加重，男性患者比例、年龄、脾脏厚度、门静脉内径、LSM值均明显增加，差异均有统计学意义（P均〈0.05）；血清ALT水平、HBVDNA定量随肝脏炎症程度的加重亦明显增加，差异均有统计学意义（P均〈0.05），但以上两指标随肝脏纤维化程度的加重无明显变化。结论对于ALT〈2×ULN的HBeAg阴性慢性HBV感染者，仍然有相当部分患者的肝脏病变在G2或／和s2以上，对于这部分人群，尤其是男性患者，密切随访年龄、血清ALT、HBVDNA、脾脏厚度、门静脉内径、LSM值的变化对于协助了解肝脏病理变化有一定的提示作用。

Objective To explore the liver pathohistological changes and pathohistology correlated clinical features of HBeAg-negative chronic hepatitis B virus infectors with ALT level less than two-time up limit of normal （ ULN）. Methods 60 patients were divided into different groups according to the different liver inflammation grades and fibrosis stages, then the sex ratio, age, serum ALT level, HBV DNA, thickness of spleen, breadth of portal vein, liver stiffness measurement （LSM） were detected by Fibroscan in these groups. Results The grades of liver inflammation in the 60 patients were G1 , G2 and G3, while the stages of liver fibrosis were SO, S1 and S2.49 （81.7%） patients had ≥ G2 hepatitis and 19 （31.7%） patients had S2 fibrosis. In these 60 patients, with the aggravating of liver inflammation and fibrosis, the male patient ratio, age, thickness of spleen, breadth of portal vein and LSM index were obviously increased, furthermore, the ALT and HBV DNA level were markedly increased with the aggravating of liver inflammation, while there were no obvious changes in the two indexes with the aggravating of liver fibrosis. Conclusion Most of the HBeAg-negative chronic hepatitis B virus infectors whose ALT 〈 2 × ULN had above G2 hepatitis and S2 fibrosis. To these patients, especially for the male patients, the age, serum ALT, HBV DNA, thickness of spleen, breadth of portal vein and LSM index can imply the liver pathohistological changes.