非活动性HBsAg携带者110例肝组织的病理学特征

Liver biopsy and clinical characteristics of inactive HBsAg carriers

目的了解非活动性HBsAg携带者的肝组织病理学改变。方法回顾性分析2011年1月至2015年9月110例接受肝脏穿刺活检术的非活动性HBsAg携带者的临床资料及其肝组织炎症活动度（A）与纤维化程度（F）。患者年龄21～66岁，其中男性76例、女性34例；〈A2者73例，≥A2者37例；〈F2者63例，≥F2者47例；血清ALT水平〈WHO正常上限（ULN）标准者59例（WHO标准组，男性30U／L、女性19U／L），〈我国ULN标准者110例（中国标准组，男性50U／L、女性40U／L）。结果110例中，≥A1者100例（90．9％）、≥A2者37例（33．6％）；≥F1者84例（76．3％）、≥砣者47例（42．7％）。男性A和F的严重程度均高于女性，以F的改变显著（U=2．162，P=0．032；X^2=5．315，P=0．021）。中国标准组与WHO标准组间A和F严重程度的差异均无统计学意义（U=0．951，P：0．341；U=0．435，P=0．663）。随着年龄的增加，A和F的严重程度增加（F=3．705，P=0．014；F=5．915，P=0．001）；≥A2和≥F2的平均年龄分别为（41．7±9．6）岁和（38．7±8．1）岁。影响A和F严重程度的独立危险因素分别是年龄、性别（男性）和年龄。结论大部分非活动性HBsAg携带者存在一定程度的肝脏病理性损伤，对I〉40岁者应进行肝脏炎症和纤维化进展的筛查，尤其是男性。

Objective To assess the liver biopsy and the clinical characteristics of inactive HBsAg carriers. Methods One hundred and ten inactive HBsAg carriers, including 76 males and 34 females aged （38.9 _＋ 9.4） years （21 - 66）, underwent liver biopsy from January 2011 to September 2015, the histopathological findings and clinical features were analyzed. Among 110 cases the inflammation activity （A） was 〈 A2 in 73 cases and I〉 A2 in 37 cases ; the fibrosis （F） 〈 F2 in 63 cases and ≥ F2 in 47 cases. The upper limits of normal （ULN） for ALT was defined as 30 U/L for men and 19 U/L for women according to World Health Organization （WHO） standard, and 50 U/L for men and 40 U/L for women according to Chinese national standard. There were 59 cases with ALT 〈 1 × ULN of WHO standard and 110 cases with ALT 〈 1 ≥ ULN of Chinese standard. Results In 110 inactive HBsAg carriers, there were 100 cases （90. 9%） ≥A1 and 37 cases （33.6%） ≥A2, 84 cases （76. 3%） ≥F1 and 47 cases （42. 7%） ≥F2. The severity of A and F were both higher in males than that in females, especially that of F （ U = 2. 162, P = 0. 032 ; X2 = 5. 315, P = 0. 021 ）. But there were no statistical differences between WHO standard group and Chinese standard group （ U = 0. 951, 0. 435; P = 0. 341, 0. 663 ）. Along with the increase of age, the degrees of A and F aggravated （F = 3. 705, 5. 915 ; P = 0. 014, 0. 001 ）. The average ages in I〉 A2 group and I〉 F2 group were （41.7 ＋ 9. 5 ） years and （ 38.7 ＋ 8. 1 ） years, respectively. The independent risk factors for severity of A and F were age, gender （male） and age, respectively. Conclusion There may be histological damages of varying degree in liver tissues of most inactive HBsAg carriers, and for those aged 40 years and over, especially males screening of liver histological activity and fibrosis would be necessary.