轻度慢性乙型肝炎患者肝组织纤维化与临床的相关性分析

Correlation between liver fibrosis and clinical manifestations in patients with mild chronic hepatitis B

目的探讨轻度慢性乙型肝炎(chronic hepatitis B,CHB)患者肝组织纤维化程度分期与临床的相关性。方法选取59例(HBe Ag阳性45例,HBe Ag阴性14例)轻度CHB患者为研究对象。所有患者均行B超检查,并进行肝穿刺活检,光镜下观察样本,将病理结果与血清ALT、AST、HBV DNA、肝纤维化标志物透明质酸(HA)及B超检查记录的肝脏门静脉(MPV)宽度进行对比分析。结果 HBe Ag阳性的轻度CHB患者HBV DNA中位滴度为8.3×107copies/ml,HBe Ag阴性的轻度CHB患者HBV DNA中位滴度为3.2×105copies/ml,两组比较,差异有统计学意义(P=0.011)。血清ALT、AST、HA值及MPV宽度在HBe Ag阳性和HBe Ag阴性的轻度CHB患者之间比较,差异均无统计学意义(P>0.05)。两组患者中,肝组织纤维化分期分别与HA值、MPV宽度呈正相关(HA:r=0.533、P=0.023和r=0.702、P=0.046;MPV:r=0.546、P=0.044和r=0.762、P=0.028);而与血清ALT、AST及HBV DNA水平均无相关性(P>0.05)。结论 HBV DNA滴度在HBe Ag阳性的轻度CHB患者中升高;轻度CHB患者的肝组织纤维化程度与HA值及MPV宽度有一定的相关性。

Objective To investigate the correlation between liver fibrosis stage and clinical manifestations in pa- tients with mild chronic hepatitis B （CHB）. Methods Fifty-nine CHB patients （including 45 HBeAg positive and 14 HBeAg negative patients） were enrolled. All subjects received B-ultrasound inspection and liver biopsy, and the liver tissue samples with hematoxylin-eosin （HE） and reticular fiber staining were observed by light microscope. The correla- tion of the main portal vein （MPV） diameters, biochemical tests （ALT, AST） , HBV DNA level, liver fibrosis indexhy- aluronic acid （HA） with liver fibrosis degree were studied. Results The median titer of HBV DNA was significantly higher in the mild CHB patients with e antigen-positive than that with e antigen negativity （8.3 × 107 copies/ml vs 3.2 × 105 copies/ml, P = 0.011）. There were not statisticaliy significant for ALT, AST, HA and MPV diameters between HBeAg positive and HBeAg-negative mild CHB patients （P 〉 0.05）. For both the HBeAg positive and HBeAg negative mild CHB patients, liver fibrosis degree was positively correlated with the HA and MPV diameters （HA. r = 0. 533, P = 0. 023 ; and r = 0. 702, P = 0. 046, respectively ; MPV ： r = 0. 546, P = 0. 044 and r = 0. 762, P = 0. 028, ＇respective- ly） , while had no correlated with the levels of ALT, AST and HBV DNA. Conclusion HBV DNA titer increased in the HBeAg positive mild CHB patients. Liver fibrosis degree is related with HA and MPV diameter in mild CHB patients.