ALT低于2倍正常值上限的慢性HBV感染者肝脏病理结果的预测因素分析

Analysis of predictors of liver injury stage in chronic HBV infection patients with ALT levels lower than 2 × ULN

目的探索在ALT<2倍正常值上限(2×ULN)的慢性HBV感染人群中,一般临床指标对肝脏病理结果的预测作用。方法收集2009年1月至2013年6月新乡医学院第一附属医院收治的122例ALT<2×ULN的慢性HBV感染者,在超声引导下行肝穿刺活组织检查术,判断肝组织炎症活动度及纤维化程度,同期化验肝功能、乙型肝炎血清标志物、HBV DNA等指标,应用Logistic回归分析法探索该类患者的一般临床指标对其肝脏病理结果的预测作用。结果 122名患者中有明显炎症或纤维化(G≥2或S≥2)者共94例(77.0%),早期肝硬化者5例(4.1%)。G<2组与G≥2组相比,除HBV DNA外,其余各指标间差异均无统计学意义;S<2组与S≥2组相比,年龄、HBeAg、HBV DNA、AST、血小板差异均有统计学意义;Logistic回归分析提示,年龄、HBeAg和AST是肝脏明显纤维化(S≥2)的独立预测因子。结论对血清ALT<2×ULN的慢性HBV感染者,年龄>40岁、HBeAg阴性、AST>40U/L者应积极进行肝穿刺活组织检查术,必要时尽早抗病毒治疗。

Objective To investigate the role of various clinical parameters in predicting liver injury stage in patients with chronic hepatitis B virus（ HBV） infection who had alanine aminotransferase（ ALT） levels lower than 2 times the upper limit of normal（ ULN）. Methods Ultrasound- guided liver biopsy was performed in chronic HBV infection patients with ALT levels lower than 2 × ULN. The activity of inflammation and degree of fibrosis in liver tissues were assessed. Meanwhile,liver function,serum HBV markers,and HBV DNA were measured. The role of these clinical parameters in predicting liver injury stage was evaluated by logistic regression analysis. Results Among 122 patients,94（ 77. 0%） had significant inflammation or fibrosis（ G≥2 or S≥2）,and 5（ 4. 1%） had early cirrhosis. There was significant difference in HBV DNA between G ≥2 group and G 2 group,but other parameters showed no significant differences between the two groups. There were significant differences in age,HBeAg,HBV DNA,AST,and platelet count between S≥2 group and S〈2 group. The logistic regression analysis showed that age,HBeAg,and AST were independent predictors of significant liver fibrosis（ S≥2）. Conclusion Liver biopsy is necessary for chronic HBV infection patients with serum ALT levels of〈2 × ULN,aged over 40 years,negative for HBeAg,or with serum AST levels of 40 U /L.