慢性乙型肝炎病毒感染者1397例肝组织病理和临床特征分析

Liver pathology and clinical characteristics of chronic HBV infection：analysis of 1 397 cases

目的：通过大样本量分析慢性乙型肝炎病毒（ HBV ）感染者的肝组织病理学改变与临床特征相关性，为无创检查的判断提供参考。方法回顾性分析1397例慢性HBV感染者的肝组织病理学和临床资料。采用Ridit分析或Spearman等级相关分析研究临床指标与患者肝组织炎症分级（G）和纤维化分期（S）的相关性。结果1397例慢性HBV感染者中，≥G2者604例（43．24％），≥S2者504例（36．08％）；男性肝组织炎症分级和纤维化分期均高于女性（ u＝3.093和2.854， P＜0.01）。≤30岁组的肝组织炎症分级和纤维化分期均低于＞30～40岁组和＞40岁组（ r＝0.259和0.303，P＜0.01；F＝4.199和12.226，11.610和24.359，P＜0.05和＜0.01）。 HBV DNA≥103拷贝／mL的HBeAg阴性患者的炎症分级高于HBeAg 阳性组和 HBV DNA ＜103拷贝／mL 的 HBeAg 阴性组（F＝8.788和5.635，P值均＜0.01），但纤维化分期只高于HBeAg阳性组（F＝12.886，P＜0.01）。随着丙氨酸转氨酶（ALT）的升高，肝组织炎症分级和纤维化分期升高（r＝0.537和0.517，P＜0.01）。在ALT为（1～＜2）×ULN且HBV DNA≥103拷贝／mL的慢性HBV感染者中，三个年龄组间炎症分级差异无统计学意义（χ2＝4.365，P＞0.05）；纤维化分期仅＞40岁组高于≤30岁组（ F＝3．177，P＜0.05）。结论对年龄＞30岁、ALT轻度异常、HBeAg阴性及可检测到HBV DNA的慢性HBV感染者推荐行肝组织病理学检查并给予抗病毒治疗，特别是男性患者；HBeAg阴性及低水平HBV DNA的慢性HBV感染者应重视肝纤维化的筛查。

Objective To analyze the correlation between liver pathology and clinical characteristics in a large series of patients with chronic HBV infections , so as to provide the data base for non-invasive medical diagnosis .Methods Liver pathology and clinical characteristics of 1 397 patients with chronic HBV infections were retrospectively analyzed . Ridit analysis and Spearman correlation analysis were performed to investigate the correlations of clinical characteristics with liver pathology of patients .Results In 1 397 patients, there were 604 patients （43.24%） with liver inflammation grading ≥G2 and 504 patients （36.08%） with fibrosis stage ≥S2.Inflammation grade and fibrosis stage of liver tissues were both higher in male patients than those in females （u=3.093 and 2.854, P〈0.01）.Inflammation grade and fibrosis stage of liver tissues in patients aged ≤30 years were lower than those in patients aged 〉30-40 years and 〉40 years （r=0.259 and 0.303, P〈0.01;F=4.199 and 12.226,11.610 and 24.359, P〈0.05 and 〈0.01）.Patients with HBeAg（ -） and HBV DNA≥103 copies/mL were of higher degrees in liver tissue inflammation compared with those with HBeAg （ ＋） and those with HBeAg （ -） but HBV DNA 〈103 copies/mL （F=8.788 and 5.635, all P〈0.01）;while the fibrosis stage in patients with HBeAg （-） and HBV DNA≥103 copies/mL was only higher than that in HBeAg （ ＋） patients （F=12.886, P〈0.01）. Liver tissue inflammation and liver fibrosis aggravated with the increase of ALT （ r=0.537 and 0.517, P〈0.01）.There was no significant difference in liver tissue inflammation among different age groups of patients with ALT （1-〈2） ×ULN and HBV DNA≥103 copies/mL （χ2 =4.365, P 〉0.05）,but there was significant difference in liver fibrosis in patients between aged 〉40 years and ≤30 years （ F=3.177,P〈0.05）.Conclusions Liver biopsy and antiviral therapy should be considered in chronic HBV infected patients with age of 〉30 years, lightly elevated ALT levels , HBeAg（-） and detectable HBV DNA levels , especially in male patients .Screening for liver fibrosis should be considered in patients with HBeAg （ -） and low HBV DNA levels .