肝活组织检查确诊乙型肝炎肝硬化的临床高危因素分析

Analysis of clinical high- risk factors for hepatitis B cirrhosis confirmed by liver biopsy

目的分析由肝活组织检查确诊乙型肝炎肝硬化的临床高危因素。方法采用1∶2配比的病例对照研究设计。收集2009年4月-2012年10月住院并行肝活组织检查的慢性乙型肝炎（CHB）患者的临床资料，将其中乙型肝炎肝硬化患者79例设为病例组（肝硬化组）；同期住院的CHB非肝硬化患者158例设为对照组（非肝硬化组）。对2组的临床相关因素进行单因素分析及Logistic多因素回归分析。单因素分析中，计数资料比较采用卡方检验，计量资料采用t检验。然后选择有统计学意义的指标进行Logistic多因素回归分析。结果单因素分析显示肝硬化组的男性例数、HBeAg阴性例数、年龄、AST、GGT、IgG、透明质酸（HA）水平明显高于非肝硬化组，而Alb、PLT、HBV DNA、层粘连蛋白（LN）水平肝硬化组明显低于非肝硬化组，2组差异均有统计学意义（P均＜0.05）。以是否肝硬化为因变量，以其他因素为自变量，进行非条件的Logistic多因素回归分析，结果显示年龄增大（β=0.046,OR=0.955）、GGT升高（β=0.040,OR=0.960）、IgG升高（β=0.179,OR=0.836）是发生肝硬化的高危因素，而Alb升高（β=-0.114,OR=1.120）、PLT升高（β=-0.024,OR=1.024）是肝硬化的保护因素。结论年龄增大、Alb减低、GGT升高、PLT减低、IgG升高是ALT波动在0~80 U/L之间的CHB患者发生肝硬化的高危因素，临床中对于此类患者应注意监测上述指标，特别是对PLT、IgG、GGT指标的检测，有针对性地进行肝活组织病理检查，避免漏诊、误诊。

ObjectiveTo analyze the clinical high-risk factors for hepatitis B cirrhosis confirmed by liver biopsy. MethodsA case-control study was conducted on the clinical data collected from 237 patients with chronic hepatitis B who were hospitalized and underwent biopsy from April 2009 to October 2012. These patients included 79 cases confirmed by liver biopsy as having liver cirrhosis （case group） and 158 cases confirmed by biopsy as not having liver cirrhosis （control group）. Univariate analysis and multivariate logistic regression analysis were used to investigate the clinical risk factors for liver cirrhosis. In the univariate analysis, comparison of categorical data was made by chi-square test, and comparison of continuous data was made by t test. The indices of statistical significance were subjected to multivariate logistic regression analysis. ResultsThe univariate analysis showed that the case group had significantly increased numbers of male cases and HBeAg-negative cases, age, and aspartate aminotransferase （AST）, gamma-glutamyl transpeptidase （GGT）, immunoglobulin G （IgG）, and hyaluronic acid levels （P〈0.05） and significantly decreased albumin （Alb）, hepatitis B virus DNA, and laminin levels and platelet （PLT） count （P〈0.05）, as compared with the control group. The unconditional multivariate logistic regression analysis showed that increasing age [β=0.046, odds ratio （OR）=0.955], elevated GGT level （β=0.04, OR=0.96）, and increased IgG level （β=0.179, OR=0.836） were high-risk factors for liver cirrhosis, while increased Alb level （β=-0.114, OR=1.120） and PLT count （β=-0.024, OR=1.024） were protective factors for liver cirrhosis. ConclusionIncreasing age, decreased Alb level , elevated GGT level, decreased PLT count, and increased IgG level are high-risk factors for liver cirrhosis in patients with chronic hepatitis B whose ALT levels range within 0-80 U/L. Active monitoring of the above indices, especially PLT, IgG, and GGT, and liver biopsy should be performed if necessary to avoid misdiagnosis of liver cirrhosis in patients with chronic hepatitis B.