乙型肝炎病毒和丙型肝炎病毒慢性感染者肝组织病理学炎症及纤维化对比分析

The comparison of liver inflammation and fibrosis between chronic HBV and HCV infection

目的通过对乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）慢性感染者进行肝组织病理学检查，探讨两者肝组织炎症和纤维化的不同特点及与丙氨酸氨基转移酶（ALT）的关系。方法收集2012年至2016年在中国医科大学附属盛京医院感染科住院的HBV慢性感染者[包括ALT≥2×正常值上限（ULN）88例和AIT〈2×ULN258例]和HCV慢性感染者，全部病例进行肝活组织检查，比较不同ALT水平的HBV和HCV慢性感染者肝组织炎症活动度及纤维化分期。计数资料采用χ2检验，非正态分布数据采用Mann-Whitney U检验，相关性分析采用Spearman等级相关性分析。结果346例慢性HBV感染者中，肝组织炎症活动度G≥2级169例（48.8％），纤维化S≥2期98例（28．3％），G≥2级且s≥2期共81例（23．40／0）；其中ALT〈2×ULN组中，G≥2级109例（42．2％），S≥2期62例（24％），G≥2级且S≥2期共49例（19％）；在ALT≥2×ULN组中，G≥2级60例（68．2％），S≥2期35例（39．8％），G≥2级且S≥2期共31例（35．2％）。ALT≥2×ULN组的肝组织炎症坏死及纤维化程度均明显高于ALT〈2×ULN组（χ2=17．66，χ2=8．06，P值均〈0．01）。57例慢性HCV感染者中，G≥2级47例（82．5％），S≥2期20例（35．1％），G≥2级且S≥2期共20例（35．1％），并且ALT水平与肝组织炎症活动度及纤维化分期无关垆〉0．05）。HCV慢性感染者肝脏炎症坏死程度明显高于ALT〈2×ULN的HBV慢性感染者（χ2=30．19，P〈0．01），而纤维化程度在两组间差异无统计学意义（χ2=2．96，P〉0．05）。慢性HCV感染者与ALT≥2×ULN的慢性HBV感染者相比，在肝组织炎症坏死和纤维化程度上差异均无统计学意义（χ2=3．65，χ2=0．32，P值均〉0．05）。结论在ALT〈2×ULN的慢性HBV感染者中，约30％～40％的患者存在着明显的肝组织炎症和（或）纤维化。约80％的慢性HCV感染者存在着明显的肝组织炎症，肝组织炎症活动度与ALT水平无关，但炎症坏死程度明显高于ALT〈2×ULN的慢性HBV感染者。

Objective To explore the difference of liver inflammation and fibrosis in patients with chronic hepatitis B virus （HBV） infection and chronic hepatitis C virus （HCV） infection, and to investigate the relationship between hepatic pathology and alanine aminotransferase （ALT）. Methods 57 patients with chronic HCV infection and 346 patients with chronic HBV infection who were hospitalized at Shengjing Hospital of China Medical University from January 2012 to September 2016 were enrolled. In chronic HBV infection, including 88 cases whose ALT were more than two times of upper limited of normal （ALT≥ 2×ULN） and 258 cases whose ALT were less than two times of upper limited of normal （ALT 〈 2×ULN）.All the patients were underwent liver biopsy. Chronic HBV infection （ALT ≥ 2×ULN and ALT 〈 2×ULN） and chronic HCV infection were compared respectively. Statistical analyses were performed using a Univariate χ2-test and Mann-Whitney U test for comparison. Correlations between variables were analyzed using Spearman＇s rank correlation. Results In chronic HBV infection group, 169 cases （48.8%） had inflammation grade ≥ 2 （G ≥ 2）, 98 cases （28.3%） had fibrosis stage ≥ 2 （S ≥ 2）, 81 cases （23.4%） with G ≥ 2 and S≥ 2.In the ALT 〈 2×ULN group, there were 109 cases （42.2%） with G ≥ 2, 62 cases （24%） with S ≥ 2, 49 cases （19%） with G≥2 and S ≥ 2. In the ALT /〉 2xULN group, 60 cases （68.2%） with G ≥ 2, 35 cases （39.8%） with S ≥ 2, 31 cases （35.2%） with G ≥2 and S ≥2. The grade of inflammation and fibrosis have significantly different between ALT ≥ 2×ULN group and ALT 〈 2×ULN group （χ2 = 17.66,Z2 = 8.06, P 〈 0.01）. In chronic HCV infection group, 47 cases （82.5%） with G χ2, 20 cases （35.1%） with S ≥ 2, 20 cases （35.1%） with G ≥ 2 and S ≥ 2. ALT had no correlation with inflammation and fibrosis （P 〉 0.05）. The grade of inflammation was significantly different between chronic HCV infection and chronic HBV infection whose ALT 〈 2xULN （×2 = 30.19, P 〈 0.01） but the fibrosis have no difference （χ2 = 2.96, P 〉 0.05）. Compared with chronic HBV infection whose ALT ≥ 2×ULN, both inflammation and fibrosis had no significantly different （χ2 = 3.65,χ2 = 0.32, P 〉 0.05 respectively）. Conclusion In chronic HBV infection whose ALT 〈 2xULN, about 30%-40% liver tissue with significant necroinflarnmation and/or fibrosis. About 80% chronic HCV infection with significant necroinflammation, and the grade of inflammation has no correlation with ALT. The grade of inflammation has significantly different between chronic HCV infection group and chronic HBV infection group whose ALT 〈 2×ULN.