轻微转氨酶升高慢性乙型肝炎患者抗病毒治疗的研究

Study on antiviral therapy for chronic hepatitis B patients with mild elevated in transaminases

目的探讨轻微转氨酶升高(ALT 1~2×ULN)慢性乙型肝炎(CHB)患者抗病毒治疗效果。方法选取2016年1月至2017年12月收治的慢性乙型肝炎患者108例作为研究对象,经《慢性乙型肝炎防治指南》标准确诊为ALT水平<2倍ULN但经肝组织活检术,肝穿刺活检示炎症坏死≥G2与纤维化≥S2的慢性乙型肝炎56例为观察组,而ALT≥2倍ULN的慢性乙型肝炎患者52例为对照组,所有患者给予恩替卡韦抗病毒治疗,经12周、24周、36周、48周后检测肝功能、HBV DNA、乙肝五项,且再次复查观察组部分患者肝脏炎症与纤维化程度。结果两组患者治疗前E抗原状态、HBV DNA水平差异无统计学意义,两组患者ALT水平差异具有统计学意义(P<0.05);两组24周、48周的ALT复常率、DNA转阴率、E抗原血清转换率对比差异无统计学意义;两组患者治疗24周、48周后ALT复常率、DNA阴转率比较差异无统计学意义;两组治疗前HBV DNA差异无统计学意义,两组治疗24周、48周后HBV DNA显著降低,且观察组低于对照组,组间差异具有统计学意义(P<0.05);1例患者从G2S3转为G1S2,1例患者从G1S3转为G1S2,1例患者从G2S3转为G1S1患者肝脏组织学损害程度较前好转。结论ALT<2×ULN的慢性乙型肝炎患者抗病毒治疗期中,HBeAg转阴率持续时间长。

Objective To investigate the antiviral treatment effect of chronic hepatitis B(CHB)patients with mild elevated in transaminases(ALT 1-2×ULN).Methods 108 patients with chronic hepatitis B admitted from January 2016 to December 2017 were selected and divided into two groups according to ALT levels,namely,observation group(ALT<2ULN,necrosis≥G2,fibrosis≥S2,n=56)and control group(ALT≥2ULN,n=52).All patients received the entecavir antiviral therapy.At the post-treatment 12 week,24 week,36 week and 48 week,hepatic function,hepatitis B virus deoxyribonucleic acid(HBV DNA),and five serological markers of HBV were detected,and the degree of liver inflammation and fibrosis of some patients in the observation group were also reviewed again.Results The E antigen status and HBV DNA level between the two groups had no difference before treatment,while difference was found in the ALT level(P<0.05).At the post-treatment 24 week and 48 week,ALT recurrence rate,DNA conversion rate,and E antigen seroconversion rate had no difference.The HBV DNA between the two groups before treatment had no difference,which was decreased in both groups at the post-treatment 24 week and 48 week(P<0.05),and were lower in the observation group than in the control group(P<0.05).Histological damage of the liver were ameliorated including 1 patient from G2S3 to G1S2,1 patient from G1S3 to G1S2,and 1 patient from G2S3 to G1S1.Conclusion In the antiviral treatment period of CHB patients with ALT<2×ULN,the HBeAg conversion rate lasts for a long time.