442例40岁以上慢性HBV携带者肝穿刺活组织检查的结果分析

Liver biopsy results of chronic HBV carriers aged above 40 years: an analysis of 442 cases

目的观察40岁以上慢性HBV携带者肝脏组织学变化。方法收集2012年8月-2015年8月吉林省肝胆病医院年龄≥40岁慢性HBV携带者442例。所有患者在B型超声引导下采用快速穿刺法取肝组织进行检查,统计G2S2以上及肝硬化患者的比例,观察HBV感染病史肝功能、BMI、Fibro Scan与肝脏组织学变化的关系。计量资料组间比较采用t检验;采用相对危险度分析危险因素;采用Kappa分析进行一致性检验。结果 442例年龄≥40岁的慢性HBV携带者中,肝纤维化分级分期≥G2S2的患者占56.56%,肝硬化患者占20.14%。HBV感染病史的长短及BMI与肝纤维化程度有一定关联,病史超过10年[比值比(OR)=64.06,95%可信区间(95%CI):33.72~121.69,P<0.001]、BMI≥24 kg/m2(OR=6.93,95%CI:4.64~10.35,P<0.001)为肝纤维化及肝硬化的危险因素。肝纤维化分级分期≥G2S2的患者与<G2S2的患者相比,ALT、AST、腺苷脱氨酶、GGT、ALP及前白蛋白水平差异均有统计学意义(t值分别为40.00、2.16、25.35、47.73、12.62、13.38,P值均<0.05)。Fibro Scan检测与肝活组织检查诊断肝硬化的一致性分析显示Kappa值为0.76,两种检查方法诊断一致性较好。结论应重视40岁以上慢性HBV携带者的监测与管理,尤其对于ALT水平>30 U/L以及Fibro Scan提示有明显纤维化的患者,需尽早行肝穿刺活组织检查。

Objective To observe the histological changes of the liver in chronic HBV carriers aged above 40 years. Methods A total of442 chronic HBV carriers aged above 40 years who underwent liver biopsy in Hepatology Hospital of Jilin Province from August 2012 to August 2015 were enrolled. Liver tissue samples were collected from all patients using ultrasound-guided rapid puncture,and the proportion of patients with grade ≥G2S2 liver fibrosis or liver cirrhosis was calculated. The association of medical history of HBV infection,liver function,body mass index（ BMI） and Fibro Scan with histological changes of the liver was analyzed. The t-test was used for comparison of continuous data between groups,relative risk（ RR） was used to analyze risk factors,and a Kappa analysis was used for consistency test. Results Of all 442 chronic HBV carriers aged ≥40 years,56. 56% had grade ≥G2S2 liver fibrosis and 20. 14% had liver cirrhosis. The length of the medical history of HBV infection and BMI were correlated with the degree of liver fibrosis,and medical history 10 years（ OR= 64. 06,95% CI： 33. 72-121. 69,P 0. 001） and BMI ≥24（ OR = 6. 93,95% CI： 4. 64-10. 35,P 0. 001） were risk factors for liver fibrosis and cirrhosis. There were significant differences between grade G2S2 liver fibrosis patients and grade ≥G2S2 liver fibrosis patients in the levels of alanine aminotransferase,aspartate aminotransferase,adenosine deaminase,gamma-glutamyl transpeptidase,alkaline phosphatase,and prealbumin（ t = 40. 00,2. 16,25. 35,47. 73,12. 62,and 13. 38,all P 0. 05）. The consistency analysis of Fibro Scan and liver biopsy in the diagnosis of liver cirrhosis showed a Kappa value of 0. 76,suggesting that there was a good diagnostic consistency between these two methods. Conclusion Monitoring and management of chronic HBV carriers aged above 40 years should be taken seriously in clinical practice,and liver biopsy should be performed as soon as possible for those with ALT 30 U/L and marked liver fibrosis suggested by Fibro Scan.