637例慢性HBV感染者自然史各期肝组织纤维化演变规律研究

Study on evolution rules of hepatic fi brosis in the natural history in 637 patients with chronic HBV infection

目的研究慢性HBV感染者自然史各期中肝组织纤维化演变规律。方法按照《慢性乙型肝炎防治指南(2010年版)》描述的CHB自然史分期的血清学特征作为纳入标准,将慢性HBV感染者分为免疫耐受期、免疫清除期、非活动或低(非)复制期以及再活动期,统计和分析各组患者的性别、年龄、ALT水平、血清HBV DNA、肝组织炎症(G)的变化特点,以及各组肝组织纤维化(S)的演变规律。结果共637例患者,其中男性501例(78.6%),女性136例(21.4%)。免疫耐受期患者101例,免疫清除期患者248例,低(非)复制期患者119例,再活动期患者169例。各期患者的相应肝组织炎症分级比较均有统计学意义,其中免疫清除期和再活动期肝组织炎症较为活跃(χ2=150.424,P<0.0001)。各期患者肝纤维化分期亦有统计学差异,其纤维化程度呈渐次加重的趋势(χ2=141.682,P<0.0001)。结论慢性HBV感染者自然史表现为肝组织炎症反复活跃、肝组织纤维化程度进行性加重的过程。

Objective To study the evolution rules of hepatic fibrosis in the different stages of the natural history of chronic HBV infection. Methods We collected patients of chronic HBV infection and divided them into four phases （the immune tolerant phase, the immune clearance phase, the low or non-replicative phase, the reactivation phase） by the standard of the Guidelines for Chronic Hepatitis B in China, version 2010. The evolution rules of ages, ALT levels, HBV DNA loads, liver tissue inlfammation and hepatic ifbrosis were analyzed. Results Total of 637 patients （501 males and 136 females） with chronic HBV infection in the natural history were recruited in this study. The 101 patients in immune tolerant phase, and 248 patients of the immune clearance phase were analyzed, 119 patients of the low or non-replicative phase were detected, 169 patients of the reactivation phase were included. The signiifcant difference was determined in the liver tissue inlfammation, especially the immune clearance phase and the reactivation phase were much active （χ2=150.424, P〈0.0001）. The ifbrosis stage among the four stages in the natural history of the HBV infection also had signiifcant difference, and gradually increased （χ2=141.682, P〈0.0001）. Conclusions The natural history of the chronic HBV infectious was a process that the liver ifbrosis was progressive exacerbation, that the liver tissue inlfammation was repeatedly active.