慢性乙型肝炎感染谷丙转氨酶持续正常患者肝脏病理相关因素分析

Analysis of related factors of ALT persistently normal patients with chronic HBV infection

目的分析慢性乙型肝炎(HBV)感染谷丙转氨酶(ALT)持续正常的患者肝脏病理相关因素,为慢性乙型肝炎病情判断提供依据。方法选取2012年5月-2014年6月接受治疗的94例慢性HBV感染ALT持续正常的患者作为研究对象,对患者肝组织病理学、血清HBV-DNA及HBeAg进行检测,分析患者的肝活检病理炎症分级和纤维化分期、年龄、HBV-DNA载量、血清HBeAg与炎症和纤维化的关系。结果 94例患者均存在炎症,51例患者存在纤维化,占54.3%,≥40岁患者的炎症活动度较严重,其中炎症活动度≥3,占66.7%,与其他年龄组相比,差异有统计学意义(P<0.05);≥40岁患者的纤维化程度较高,与其他年龄组比较,差异有统计学意义(P<0.05);炎症活动度≥3、纤维化分期≥3的患者HBV-DNA载量均高于炎症活动度≤2、纤维化分期≤2的患者,而≥40岁的患者HBV-DNA载量高于其他年龄组,血清HBeAg阴性和阳性组炎症活动度≤2、纤维化分期≤2的病例数与炎症活动度≥3、纤维化分期≥3比较,差异均有统计学意义(P<0.05)。结论对于ALT持续正常的慢性HBV感染者均存在不同程度的肝组织病理学的改变,其中>40岁、病毒数量及HBeAg阳性患者更要注意,必要时行肝组织活检。

OBJECTIVE To analyze the related factors of ALT persistently normal patients with chronic HBV infection so as to provide a basis for judging the condition of chronic hepatitis.METHODS Totally 94 cases of ALT persistently normal patients with chronic HBV infection from May 2012 to Jun.2014 in our hospital were treated.The liver histopathology,serum HBV-DNA,and HBeAg were tested,and the relationship between liver biopsy inflammation grade and fibrosis stage,age,HBV-DNA load,serum HBeAg was analyzed.RESULTS All the 94cases（100%）had inflammation,and 51cases（54.3%）had fibrosis.Inflammatory activity in patients≥40years of age was more serious,compared with other age groups,and the difference was significant（P〈0.05）;the degree of fibrosis in patients≥40years of age was higer compared with other age groups,and the differences were significant（P〈0.05）.G≥3,S≥3patients had a higher HBV-DNA load than those patients with G≤2,S≤2,and HBV-DNA load in patients over 40 years old were higher than other age groups.In serum HBeAg negative and positive group,G≤2comparison between cases with S≤2G≥3,S≥3,the differences were significant（P〈0.05）.CONCLUSIONFor ALT persistently normal patients with chronic HBV infection,there is a change in liver histopathology in varying degrees,of which over 40 years,the number of viruses and HBeAg-positive patients have to pay attention,if necessary,to liver biopsy.