家族聚集性慢性乙型肝炎病毒感染者自然病程与相关因素的研究

Study on natural progressive course and relative factors of chronic hepatitis B virus infection with family cluster

目的明确慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者自然病程进展规律与感染持续时间、年龄、性别、血清ALT水平及肝组织病理学的关系。方法收集2007年1月-2010年8月就诊于中国医科大学附属盛京医院感染科的家族聚集性慢性HBV感染患者,排除其他肝脏疾病,未应用干扰素或核苷类似物抗病毒治疗,肝脏组织病理切片采用Knodell评分系统读取,统计学方法采用描述统计学评价,卡方检验及线性回归分析,只有与单变量分析(P<0.05)密切相关的因素才进入多因素分析模式。结果132例患者中年龄>30岁组炎症评分≥5分及纤维化评分≥3分所占频率明显高于年龄≤30岁组(P<0.05);肝功正常组肝组织炎症评分≤4分及纤维化评分≤2分所占频率高于肝功异常组(P<0.05);肝功反复异常>1年组肝组织炎症评分≥5分及纤维化评分≥3分所占频率高于肝功反复异常≤1年组(P<0.05)。血清ALT水平正常组肝组织炎症评分≤4分及纤维化评分≤2分所占频率高于ALT水平异常组(P<0.05);ALT>2×ULN组肝组织炎症评分≥5分及纤维化评分≥3分所占频率高于ALT≤2×ULN组(P<0.05)。结论家族聚集性慢性HBV感染者肝组织炎症及纤维化程度与感染持续时间呈正相关;尤其年龄>30岁时更易出现肝脏疾病的进展;持续肝功异常时间越长肝脏炎症及纤维化改变越显著;血清ALT异常的慢性HBV感染者肝组织炎症及纤维化程度较血清ALT正常者重,而血清ALT异常者血清ALT水平越高,肝组织炎症及纤维化改变越显著。

Objective To investigate the relationship between natural progressive course of chronic hepatitis B virus（HBV） infection and the factors such as the time length of infection,age,sex,ALT level and liver biopsy. Methods Chronic HBV infection with family cluster who were treated in Shengjing Hospital of China Medical University from Jan.2007 to Aug. 2010. without other liver diseases,without treatment of interferon or analogues antiretroviral were collected. Liver tissue pathological slices were read with Knodell score system; statistical methods were descriptive statistics,Chi-square test and linear regression analysis,only univariate analysis（ P 0. 05） closely related factors could enter multiple factors analysis model. Results Among the 132 patients,the frequencies of group in the inflammation score≥5 and fibrosis score ≥3 when age 30 years old,which was higher than the group of age≤30 years old. The frequencies in inflammation score≤4 and fibrosis score≤2 in liver function normal group,which was higher than the liver function abnormal group. The liver function kept on abnormal 1 year had higher frequencies than the liver function kept on abnormal≤1 year,in the inflammation score≥5 and fibrosis score≥3 group. The frequencies in inflammation score≤4and fibrosis score≤2 in serum ALT normal group,which was higher than that in serum ALT abnormal group. And the frequencies in the group inflammation score ≥5 and fibrosis score ≥3 when serum ALT 2 × ULN,which was higher than the group of ALT≤2 × ULN. Conclusion The time length of infection have positive correlation to the severity of liver inflammation and fibrosis of chronic HBV infection with family cluster. It shows that progress of liver disease appear easily when age 30 years old. The longer of liver function abnormal, the liver inflammation and fibrosis are more serious.