慢性乙型肝炎患者临床和肝组织病理学特点及影响肝纤维化因素分析

Pathological and clinical features and factors affecting significant liver fibrosis in patients with chronic hepatitis B

目的分析HBe Ag阴性与阳性慢性乙型肝炎(CHB)患者临床和肝组织病理学特点,探讨影响CHB患者发生明显肝纤维化的危险因素。方法回顾性分析250例CHB患者血清HBV DNA水平、Fibroscan检测肝脏硬度(stiffness)值和肝穿刺组织病理学特点,应用多因素Logistic回归模型分析影响CHB患者发生明显肝纤维化的独立危险因素。结果 160例HBe Ag阴性患者血清HBV DNA≥1×105 copies/ml者所占比例显著低于HBe Ag阳性组(66.9%对99.4%,P<0.05);HBe Ag阴性组血清ALT和AST水平显著低于HBe Ag阳性组(P<0.05);血清HBe Ag阴性组与阳性组肝组织炎症分级和纤维化分期总体分布差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示年龄≥40岁、HBV DNA水平高、PTA低和Stiffness水平高为CHB患者存在明显肝纤维化的独立危险因素。结论血清HBe Ag阴性与阳性CHB患者存在一些临床和肝组织病理学特征的差异,血清HBe Ag阴性患者可能存在更为严重的临床和预后问题,需要给予特别的关注和管理。

Objective To investigate the pathological and clinical features and factors affecting significant liver fibrosis in patients with chronic hepatitis B（CHB）.Methods The clinical data and liver biopsies in 250 patients with CHB were analyzed retrospectively,and serum HBV DNA loads and 1 iver stiffness measurements were obtained.The factors affecting liver fibrosis was analyzed by Logistic analysis.Results The rate of patients with high serum HBV DNA loads was lower in 160 patients with serum HBe Ag negative（66.9% vs.99.4%,P〈0.05）as compared to that in 60 with serum HBe Ag positive;serum levels of ALT and AST in patients with serum Hbe Ag negative were siginificantly lower than in serum HBe Ag positive group（P 〈0.05）;the hepatic activity grading and fibrosis staging in the two groups had no statistically significant differences（P 〉0.05）;multivariate Logistic regression analysis showed that age ≥40 yr,higher serum HBV DNA loads,lower PTA and high liver stiffness were the independent risk factors for significant liver fibrosis in patients with CHB.Conclusion There are many obvious clinical and histopathological differences in patients with serum HBe Ag negative and positive,and the clinicians might take more attention to patients with serum HBe Ag negative.