HBeAg阴性高病毒载量谷丙转氨酶≤2倍正常值上限慢性HBV感染者伴明显肝脏组织学改变的独立预测因素

The independent predictors of significant liver histopathological changes in chronic hepatitis B virus infection patients with alanine aminotransferase≤two times upper limit of normal,HBeAg negative and high viral load

目的探索HBe Ag阴性高病毒载量谷丙转氨酶(alanine transaminase,ALT)≤2倍正常值上限(upper limit of normal,ULN)慢性HBV感染者伴明显肝脏组织学改变(significant liver histopathological changes,SLHC)的独立预测因素。方法回顾性分析113例初治HBe Ag阴性高病毒载量(HBV DNA≥104copies/ml)ALT≤2 ULN(ULN定义为50 IU/L)的慢性HBV感染者。采用T检验、Mann Whitney秩和检验和卡方检验比较各变量的组间差异。单因素和多因素分析筛查SLHC的独立预测因素。结果入组113例患者,其中43例(38.1%)伴SLHC,70例(61.9%)不伴SLHC。多因素分析发现HBV DNA(OR=1.560,P=0.032)和谷氨酰转肽酶(gamma-glutamyl transpeptidase,GGT)(OR=1.089,P=0.022)是HBe Ag阴性高病毒载量ALT≤2 ULN慢性HBV感染者伴SLHC的独立预测因素。4 log10 copies/ml≤HBV DNA≤6 log10 copies/ml组患者SLHC发生率明显低于HBV DNA>6 log10 copies/ml组患者(32.3%vs 61.9%,P=0.003);GGT≤50 IU/L组患者SLHC发生率明显低于GGT>50 IU/L组患者(33.3%vs 60%,P=0.024)。结论 HBe Ag阴性高病毒载量ALT≤2 ULN慢性HBV感染者中,HBV DNA>6 log10 copies/ml或GGT>50 IU/L的患者伴SLHC的可能性更大,更加迫切需要肝穿刺组织学评估。

Objective To investigate the independent predictors of significant liver histopathological changes （SL- HC） in chronic hepatitis B virus infection （CI-IBVI） patients with alanine aminotransferase less or equal to two times up-per limit of normal （ ULN）, high viral load and HBeAg negative. Methods This retrospective study enrolled 113 treat- ment-naive CHBVI patients with ALT ≤ 2 ULN （ULN defined as 50 IU/L）, high viral load （HBV DNA ≥ 104 copies/ml） and HBeAg negative. T test, Mann Whitney test, and Chi-square χ^2 test were used to compare the difference of various parameters between two groups. Univariate and multiple analysis were performed to identify the independent predictors of SLHC. Results In 113 patients, 43 cases （38.1%） had SLHC and 70 cases （61.9%） had none-SLHC. Multivariate analysis showed that HBV DNA （ OR = 1. 560, P =0. 032） and gamma-glutamyl transpeptidase （GGT） （ OR = 1. 089, P = 0. 022） were independent predictors of SLHC in CHBVI patients with ALT ≤2 ULN, high viral load, and HBeAg negative. The prevalence of SLHC was lower in patients with 4 log 10 copies/ml ≤ HBV DNA ≤ 6 logl0 copies/ml （32.3% vs61.9%, P=0.003） or GGT≤50IU/L （33.3% vs60%, P=0.024） compared withHBVDNA〉6 log10 copies/ml or GGT 〉 50 IU/L, respectively. Conclusion Among HBeAg negative CHBVI patients with ALT≤2 ULN and high viral load, those with HBV DNA 〉 6 log10 copies/ml or GGT 〉 50 IU/L have a higher likelihood of SLHC, and urgently need to be assessed by liver biopsy.