80例慢性HBV感染者临床与肝组织病理学分析

Liver histological changes and HBsAg and HBcAg expression in patients with chronic hepatitis B and low serum ALT levels

目的探讨血清丙氨酸氨基转移酶(ALT)低于2倍正常值上限(ULN)的慢性乙型肝炎病毒(HBV)感染者临床特征和肝组织病理学的变化。方法在2010年7月至2013年11月住院行肝活检的80例慢性HBV感染者,常规检测血清HBeAg和HBV DNA水平,回顾性分析其临床资料和肝组织学改变。结果 50例HBeAg阳性和30例HBeAg阴性患者年龄分别为(28.52±9.10)岁和(39.37±10.14)岁,HBV DNA载量分别为(7.79±0.73)lg拷贝/毫升和(4.52±1.67)lg拷贝/毫升,差异均有统计学意义(P<0.01);两组肝组织炎症活动度分别为(1.00±0.57)和(1.27±0.45),纤维化程度分别为(0.38±0.57)和(1.07±1.11),差异均有统计学意义(P<0.05);两组肝组织HBsAg表达强度免疫染色评分(ISS)分别为(0.93±0.92)和(0.77±0.93),HBcAg分别为(1.58±0.88)和(1.63±0.92),差异均无统计学意义(P>0.05);22例患者年龄≥40岁和35例年龄<30岁患者肝组织炎症活动度分别为(1.32±0.48)和(0.69±0.58),纤维化程度分别为(1.00±1.27)和(0.40±0.50),差异均有统计学意义(P<0.05);52例男性和28例女性患者肝组织炎症活动度分别为(1.12±0.55)和(1.07±0.54),纤维化程度分别为(0.71±0.82)和(0.50±0.96),肝组织HBsAg表达强度(ISS)分别为(0.89±0.89)和(0.82±1.00),HBcAg分别为(1.44±0.94)和(1.24±1.09),差异均无统计学意义。结论对年龄≥40岁且HBeAg阴性的血清ALT低于2×ULN的慢性HBV感染者,应及早行肝组织病理学检查,以进行正确的病情评估。

Objective To explore the liver histological changes and HBsAg and HBcAg expression in patients with chronic hepatitis B and low serum alanine aminotransferase（ALT） levels（2×upper limit of normal,ULN）. Methods Eighty patients with chronic hepatitis B virus infection received liver biopsies from July 2010 to November 2013 in this study. The liver histopathologic changes were analyzed and HBsAg and HBcAg expression in liver tissues were detected by immunostaining. Results The average age in 50 HBeAg-positive patients was（28.52±9.10） years,significantly younger than 30 HBeAg-negative patients [（39.37±10.14）years,P〈0.01];The serum HBV DNA load in HBeAg-positive patients was（7.79±0.73） lg copies/ml,significantly higher than that in HBeAg-negative patients [（4.52±1.67） lg copies/ml,P〈0.01];The liver inflammation grades and fibrosis staging in HBeAg-positive patients were（1.00 ±0.57） and（0.38 ±0.57）,significantly lower than those in HBeAg-negative patients [（1.27±0.45） and（1.07±1.11）,repectively,P〈0.01];There were no significant differences in immunostaining scores（ISS） of HBsAg [（0.93±0.92）and（0.77±0.93）,P〈0.05] or HBcAg [（1.58±0.88） and（1.63±0.92）,P〈0.05] between the two groups;The liver histological inflammation grades and fibrosis staging in 22 patients over40 years of age were（1.32±0.48） and（1.00±1.27）,respectively,significantly higher than those in 35 patients younger than 30 years of age [（0.69±0.58） and（0.40±0.50）,respectively,P〈0.01];No significant differences were observed between both genders in either liver inflammation grades [（1.12 ±0.55） and（1.07 ±0.54）] or fibrosis staging [（0.71±0.82） and（0.50±0.96）];There were no significant differences in ISS of HBsAg [（0.89±0.89） and（0.82±1.00）] or HBcAg [（1.44±0.94） and（1.24±1.09）] between males and females. Conclusions Patients over40 years of age with hepatitis B virus infection are recommended for liver biopsies in time in order to elucidate the histopathological changes.