肝功能正常的慢性HBV感染者肝组织病理改变与临床关系

Liver Pathological Changes of Chronic Hepatitis B Virus Carriers and Their Relationships to Clinics in Patients of Normal Liver Functions

目的:探讨肝功能正常的慢性乙型肝炎病毒(HBV)感染者肝组织病理特征,并分析血清HBV DNA定量与肝组织病理改变的关系.方法:选取肝功能正常的慢性HBV感染者88例,行肝穿刺病理检查,同时分析临床资料.结果:88例患者中100%存在肝组织损伤,其中肝硬化6例(6.8%),慢性乙型肝炎轻度41例(46.6%)、中度28例(31.8%)、重度13例(14.8%).82例病理诊断慢性乙型肝炎的患者中,炎症分级G≥2者59例(72.0%)、纤维化分期S≥2者41例(50.0%).HBV-DNA水平与肝组织炎症和纤维化程度无关.随年龄增加肝组织纤维化呈加重的趋势(P<0.01).结论:肝功能正常的慢性HBV感染者存在不同程度肝脏组织学改变.血清HBV DNA不能反映肝脏损伤情况,年龄越大纤维化程度越重,特别是年龄≥40岁.

Objective： To explore the relationship between the qualification of the hepatitis B Virus （HBV） DNA and the histopathologic changes of livers in chronic hepatitis B virus carriers with normal liver function. Methods： Liver biopsy and serological examination were performed in 88 randomly selected chronic hepatitis B virus carriers with normal liver functions. Groups were divided based on serum HBV DNA levels. Compari- sons of liver inflammation and fibrosis stages were conducted between groups. Results： All of the 88 subjects had liver injury. Six cirrhosis （6.8%）, 41 slight CHB （46. 6%）, 28moderate CHB （31.8%） and 13 severe CHB （14.8%） were detected. Among 82 patients pathologically diagnosed as CHB, 59（72.0%） had inflam- mation stage G≥2, 41（50. 0 %） had fibrosis stage S≥2. HBV-DNA level had any predictive meaning to the scores of the histological findings. However scores of histological changes increased sharply in parallel with an age increase of older than 40 years. Conclusion： Liver histological changes in the chronic HBV carriers with normal liver function were varied. Serum HBV DNA could not reflect the actual condition of liver injury. The liver fibrosis became more severe with the patient＇s ages, especially whose ages were over 40 years old.