肝功能正常或轻度异常的慢性HBV感染者肝组织病理改变分析

Analysis on the liver histology of 229 chronic hepatitis B patients with normal or slightly elevated alanine aminotransferase level

目的：对ALT正常或轻度异常尤其年龄偏大，有HBV感染家族史的患者行肝组织活检，了解该部分患者肝组织学特征及其肝脏炎症及纤维化程度，以便实时地给患者进行抗病毒治疗提供理论依据。方法选择首都医科大学附属北京地坛医院2005至2010年住院行肝组织活检的慢性HBV感染者，入组者符合慢性乙型肝炎诊断标准，排除合并其他病毒感染及其他肝病、严重心肺疾病等。采集患者基本信息包括性别、年龄、乙型肝炎家族史、饮酒史及用药史。肝组织学穿刺术前需检查血常规、凝血酶原活动度、肝功能、HBV DNA、腹部彩色多普勒超声；常规肝组织活检，结果用肝脏炎症分级（G0～G4）及纤维化分期（S0～S4）表示。以肝组织炎症分级分成轻度炎症（G0～G1）和明显炎症（G2～G4），以肝组织维化分期分成轻度纤维化（S0～S1）和明显纤维化（S2～S4）。结果符合入组条件的患者共229例，其中男性160例，女性69例；ALT持续正常者（PNAL）104例，ALT轻度异常组125例。全部入组患者肝病理学分析显示：肝脏炎症分级≥G2期者占45.42%；肝脏纤维化分期≥S2期者占35.38%。随ALT水平的升高，患者的肝脏炎症分级与纤维化分期增高，148例未接受抗病毒治疗的慢性HBV感染者在2～5年随访中，29.7%（44/148）患者ALT水平波动在40～50 U/L，70.3%（104/148）的患者ALT水平、HBV DNA水平均无显著波动（P＞0.05）；3例（2.1%）患者发生HBeAg血清学转换，分别发生在27岁、31岁和19岁时。结论 ALT正常或轻度异常者中有相当一部分患者存在明显的肝脏炎症及纤维化；即使肝组织活检炎症、纤维化较轻，也有相当一部分患者在2～5年内会出现肝病进展，需引起注意。

Objective To investigate the liver histological features and the relative influencing factors of the chronic hepatitis B （CHB） patients with persistently normal or slightly elevated alanine aminotransferase （ALT） level, all of the patients recruited accepted liver biopsy with a normal or mild evaluation of ALT, especially those who were older or had a family history of hepatocelluar carcinoma. And to investigate whether the biopsy feature could supply theoretical foundation for antivirus therapy. Methods Total of 229 CHB patients from 2005 to 2010, who accepted liver biopsy in Beijing Ditan Hospital, Capital Medical University were enrolled. The subjects met the diagnostic criteria （chronic hepatitis guideline） and exclusion criteria. All study participants were only infected with HBV, excluding virual hepatitis, severe cardiovascular diseases, etc, whose ALT level less was than 2 ＆#215; ULN. The related inlfuencing factors were analyzed, retrospectively. Clinical data, such as gender, age, family history, history of alcohol and drug abuse history of the inpatients were collected, respectively. Results There were 160 male and 69 female＆amp;nbsp;patiens. The percentage of whom with persistent normal （PNAL） ALT level was 45.41% （104/229）, and mild ALT evaluating was 54.59%（125/229）. Liver biopsy histologic analysis showed the percentage of liver inlfammation and ifbrosis≥G2 grade,≥S2 stage were 45.42%and 35.38%, respectively;accompanied by the rising ALT, the degree of the liver inlfammation and ifbrosis were getting higher. After a 5-year follow-up, there were 148 patients with HBV infection, who never accepted antivirus therapy, had a mild rise of ALT level （40-50 U/L） with 29.7%（44/149）, while 70.3%（104/148） patients had no change of ALT or HBV load （P＆gt;0.05）, and there were 3 （2.1%） patients with HBeAg seroconversion, happened at the age of 27, 31 and 19. Conclusions Some of the patients with normal or slightly elevated ALT may have severe liver inflammation and fibrosis. Although whose liver inflammation and fibrosis was slight abnormal, many of them would had progress in liver diseases, what should be paid attention to.