ALT持续正常的HBeAg阴性的HBV感染者肝组织损伤情况及其危险因素分析

Histological Injury and Its Risk Factors of HBeAg-negative Chronic Hepatitis B Virus-infected Patients with Persistently Normal Alanine Aminotransferase Levels

目的探讨ALT持续正常的HBe Ag阴性慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者肝组织损伤情况及其危险因素。方法对94例ALT持续正常的HBe Ag阴性慢性HBV感染者进行肝活检,比较肝组织病理不同的患者之间的性别、年龄、家族史、HBV-DNA水平、HBs Ag的差别,并采用Logistic模型进行独立危险因素的分析。结果 94例患者中炎性坏死分级≥G2的占74.5%,纤维化分级≥S2的占27.7%。炎性坏死分级≥G2组比<G2组年龄大、ALT高、HBV-DNA载量高,而且以男性为主常伴有乙型肝炎家族史。纤维化分期≥S2组比<S2组年龄大、ALT高,常伴有乙型肝炎家族史,但在HBV-DNA载量及性别构成方面差异无统计学意义。HBV-DNA和家族史是肝脏炎性坏死≥G2的独立危险因素,而家族史又是纤维化分期≥S2的独立危险因素。结论 ALT正常的HBe Ag阴性的HBV感染者,无论ALT及HBV-DNA水平的高低,实施肝组织穿刺活检是必需的。尤其是对病毒水平高且有乙型肝炎家族史者应积极开展肝穿刺。

Objective To investigate the histological injury as well as the risk factors for the course of HBeAg - negative chronic hepatitis B virus（HBV） -infected patients with persistently normal alanine aminotransferase （ALT） levels （PNAL）. Methods Ninty four patients of HBeAg - negative chronic HBV - infected with PNAL were performed liver puncturing. The ALl＇, HBV markers, and liver histological changes were detected. The gender, age, family history, HBV - DNA and HBsAg levels were compared between different pa- tients with liver inflammation and fibrosis. And the Logistic model was used during the analysis of independent risk factor. Results A- mong 94 cases, patients with inflammatory necrosis classification ≥ G2 accounted for 74.5% , fibrosis grading ≥ S2 accounted for 27. 7%. Patients in the group of inflammatory necrosis classification ≥ G2 was older than the group of 〈 G2, and the ALT level of ≥ G2 group was higher, as well as a higher HBV -DNA. What is more,Patients in the group of inflammatory necrosis classification ≥ G2 were mainly male, and were associated with a family history of hepatitis B. Patients in the group of fibrosis stage ≥S2 was older than 〈 S2 group, and the ALT level of fibrosis stage ≥S2 group was higher. And those patients were often associated with a family history of hepati- tis B, but there was no significant difference among the HBV - DNA level and gender constitution. HBV - DNA and family history were the independent risk factors of liver inflammation necrosis ≥ G2, and family history was the only independent risk factor of fibrosis stage ≥S2. Conclusion The patients of HBeAg - negative chronic HBV - infected with PNAL, regardless of the ALT and HBV - DNA, must have a liver biopsy. The patients with high level of HBV - DNA and with a family history of hepatitis B should be performed liver punctu- ring accordingly.