丙氨酸转氨酶轻度异常的慢性乙型肝炎患者病毒复制标记物与肝组织病理改变的关系

Relationship between viral replication markers and liver pathological change in chronic hepatitis B patients with mildly elevated ALT

目的了解丙氨酸转氨酶（ALT）轻度异常（1~2倍正常值上限）的慢性乙型肝炎患者肝脏病理特点,以探讨血清HBe Ag和HBV DNA定量与肝脏病理改变的关系。方法选取ALT轻度异常的慢性乙型肝炎患者387例,行肝穿刺病理检查、肝功能、血清HBV DNA及乙肝血清学标记物检测。结果 387例患者中病理诊断为慢性乙型肝炎轻度211例（54.5%）、中度83例（21.4%）、重度29例（7.5%）,病理无明显改变者58例（15.0%）;炎症分级G≥2者118例（30.5%）;纤维化分期S≥2者90例（23.3%）,肝硬化16例（4.1%）。HBe Ag阳性组与阴性组的病理炎症分级分布差异无统计学意义（P=2.229）,两组的纤维化分期分布差异有统计学意义（P=0.004）。HBV DNA载量与肝脏炎症分级、肝纤维化分期均呈负相关。结论多数ALT轻度异常的慢性乙型肝炎患者有不同程度肝组织炎症和肝纤维化,肝纤维化分期越高、肝脏炎症分级越高者HBV DNA滴度越低。

Objective To study the liver pathological characteristics of chronic hepatitis B（ CHB）patients with mildly elevated alanine aminotransferase（ ALT）（ 1 × ULN≤ALT≤2 × ULN）,and to explore the relationship between serum HBe Ag,the quantification of HBV DNA and the liver pathologic change.Methods Three hundred and eighty-seven CHB patients with mildly elevated ALT were selected,and all of them were examined with liver biopsy,liver function,HBV-DNA level and serological markers of hepatitis B virus. Results The pathological diagnosis of 387 cases included cirrhosis in 16 cases（ 4. 1%）,slight CHB in 211（ 54. 5%）,moderate CHB in 83（ 21. 4%）,severe CHB in 29（ 7. 5%） and no significant change in 58（ 15. 0%）. And then,the inflammation grade of 118 cases（ 30. 5%） and the fibrosis stage of 90 cases（ 23. 3%） were not less then two. According to some statistics,there was significant difference in the fibrosis stage between HBe Ag negative and positive group（ P = 0. 004）,with no significant difference in the inflammation grade between them（ P = 2. 229）. In addition,HBV DNA level was negatively correlated with both the liver inflammation grade and the liver fibrosis stage. Conclusions Most CHB patients with mildly elevated ALT have varying degrees of liver inflammation and fibrosis. Besides,the higher the liver fibrosis stage and the liver inflammation grade,the lower the HBV DNA titers.