ALT正常和轻度升高慢性HBV感染者的年龄与肝组织病理及HBVDNA定量的相关分析

Analysis of correlations of age with liver pathological change and HBV DNA level in chronic HBV infection patients with normal ALT and mild ALT elevation

目的探讨不同年龄的ALT正常和轻度升高慢性HBV感染者的肝组织病理及HBV DNA定量的特点。方法对2005年1月至2013年12月石家庄市第五医院收治的1123例ALT正常和轻度升高且行肝穿刺活组织检查的慢性HBV感染者进行回顾性分析,依据年龄分为<40岁和≥40岁两组,分析两组中HBe Ag阳性与阴性及ALT正常与轻度升高患者的肝组织病理炎症分级(G)和纤维化分期(S)分布特点,并进行年龄与炎症分级、纤维化分期、HBV DNA定量的相关性分析。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,采用Spearman进行等级相关分析。结果与<40岁组相比,≥40岁组患者肝组织炎症分级≥G2的比例明显增高,差异均有统计学意义(P值均<0.001);无论是HBe Ag阳性还是HBe Ag阴性,ALT水平正常或轻度升高的患者均随着年龄增大其肝纤维化分期在≥S2所占比例明显增多,差异均有统计学意义(P值均<0.001);年龄与炎性分级、纤维化分期均呈正相关(r值分别0.219、0.293,P值均<0.001);≥40岁组中HBe Ag阴性、ALT轻度升高的患者其HBV DNA定量与<40岁组患者相比,差异具有统计学意义(P<0.05)。结论 ALT正常和轻度升高慢性HBV感染者肝组织炎症分级、纤维化分期均随年龄的增加有所增加,可考虑将年龄作为病情进展的因素之一。

Objective To investigate the liver pathological changes and features of hepatitis B virus （HBV）DNA in chronic HBV infection patients with normal alanine transaminase （ALT）and mild ALT elevation.Methods A total of 1 123 chronic HBV infection patients with normal ALT and mild ALT elevation who were admitted to the Fifth Hospital of Shijiazhuang and had liver biopsy from January 2005 to De-cember 2013 were retrospectively analyzed and divided into 〈40 years group and ≥40 years group.The inflammation grade of liver tissue （G）and stage of fibrosis （S）among patients with positive and negative HBeAg and with normal ALT and mild ALT elevation in the two groups were analyzed.The correlations of age with inflammation grade,fibrosis stage,and HBV DNA level were also analyzed.Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi -square test.Then Spearman correlation analysis was performed.Results Compared with the 〈40 years group,the≥40 years group had a significantly higher proportion of≥G2 patients （P〈0.001）.Patients with normal ALT and mild ALT elevation,regardless of positive or negative HBeAg,had a significantly higher proportion of≥S2 individuals with increasing age （P〈0.001）.Age was positively correlated with inflammation grade and fibrosis stage （r=0.219 and 0.293,P〈0.001 for both）.Compared with patients in the 〈40 years group,patients with negative HBeAg and mild ALT elevation in ≥40 years group had significantly different HBV DNA levels （P〈0.05 ）.Conclusion The inflamma-tion grade of liver tissue and fibrosis stage in chronic HBV infection patients with normal ALT and mild ALT elevation increase with age, which can be considered as a factor for the progression of disease.