肝组织炎症与纤维化预测抗HBV疗效比较与探讨

Study of different pathological changes of liver tissue to predict the efficacy of anti-hepatitis B virus

目的评估并比较CHB患者肝组织炎症及纤维化等级,预测抗病毒疗效的能力。方法将ALT≥4倍正常上限(ULN)和(或)HBV DNA≤6.55 log10拷贝/ml设定为具备预测抗HBV有效的能力指标,纳入365例资料完整的CHB患者,根据患者肝组织炎症及纤维化程度不同分为四组,Ⅰ组(炎症<G2,纤维化<S2),Ⅱ组(炎症≥G2,纤维化<S2),Ⅲ组(炎症<G2,纤维化≥S2),Ⅳ组(炎症≥G2,纤维化≥S2),统计各组与ALT、HBV DNA两个指标的相关性。结果 365例患者根据不同肝组织炎症及纤维化程度分为Ⅰ组(167例)、Ⅱ组(48例)、Ⅲ组(107例)、Ⅳ组(43例),4组ALT≥4 ULN例数分别为18、7、11、17例;4组HBV DNA≤6.55 log10拷贝/ml例数分别为38、8、54、17例;4组满足ALT≥4 ULN和(或)HBV DNA≤6.55 log10拷贝/ml的比例分别为31.7%、22.9%、57.0%、65.1%。经χ2检验,Ⅰ组与Ⅱ组、Ⅲ组与Ⅳ组差异均无统计学意义,其余各组间差异均有统计学意义(P均<0.001)。结论 CHB肝组织显著纤维化指标比肝组织炎症指标具备更突出的预测抗病毒疗效能力。

Objective To evaluate and compare the level of liver infl ammation and fibrosis in patients with chronic hepatitis B（CHB）, and its ability of predicting antiviral efficacy. Methods We select ALT ≥ 4 ULN and HBV DNA ≤ 6.55 log10 copies/ml as the indicators to predict effective anti-hepatitis B virus. There are 365 patients were recruited in the study, according to different damage of liver infl ammation and fibrosis, patients were divided into four groups： group Ⅰ（the grade of infl ammation G2 and the stage of fibrosis 〈S2）, group Ⅱ（the grade of infl ammation ≥ G2 and the stage of fibrosis 〈S2）, group Ⅲ（the grade of infl ammation 〈G2 and the stage of fibrosis ≥ S2）, group Ⅳ（the grade of infl ammation ≥ G2 and the stage of fibrosis ≥ S2）, statistics the correlation of each group with the two ability index（ALT ≥ 4 ULN and HBV DNA ≤ 6.55 log10 copies/ml）. Results There were 365 patients divided into group Ⅰ（167 cases）, group Ⅱ（107 cases）, group Ⅲ（48 cases） and groups Ⅳ（43 cases）. The group Ⅰ have 18 cases with ALT ≥ 4 ULN, group Ⅱ of 7 patients, group Ⅲ of 11 patients, and 17 patients were included in group Ⅳ. There were 38 patients with HBV DNA ≤ 6.55 log10 copies/ml in group Ⅰ, group Ⅱ of 8 patients, group Ⅲ of 54 patients, and 17 patients were included in group Ⅳ. The percentage of comply ALT ≥ 4 ULN and/or HBV DNA ≤6.55 log10 copies/ml in four groups were 31.7%, 22.9%, 57.0% and 65.1%. There were no statistical difference in group Ⅰ and group Ⅱ, group Ⅲ and group Ⅳ by chi-square test, significant differences were observed among any remainder two groups（all P〈0.001）. Conclusions The predictive ability of significant liver fibrosis is relatively more prominent than active liver infl ammation.