ALT小于2倍正常上限的HBeAg阳性慢性HBV感染者肝纤维化的影响因素分析

Analysis of influencing factors of liver fibrosis in HBeAg-positive chronic HBV infection patients with ALT less than 2 times the upper limit of normal

目的探讨丙氨酸氨基转移酶(ALT)<2倍正常上限(2×ULN)的HBeAg阳性慢性乙型肝炎病毒(HBV)感染者的肝组织学病理特点,研究影响肝纤维化进展的相关因素。方法采用回顾性研究,选择2013年10月至2018年8月在延安大学附属医院感染病科住院行肝穿刺活检的ALT<2×ULN的HBeAg阳性慢性HBV感染者290例,根据病理结果分为轻微肝纤维化组(F 0~F 1)和明显肝纤维化组(F 2~F 4)。采用单因素及多因素Logistic回归分析筛选可协助诊断明显肝纤维化的无创临床指标。结果纳入患者290例,其中轻微肝纤维化组219例,明显肝纤维化组71例。多因素Logistic回归分析结果显示,低HBsAg、高天门冬氨酸氨基转移酶(AST)和肝脏硬度值(LSM)是明显肝纤维化的独立危险因素。结论HBsAg、AST和LSM对ALT<2×ULN的HBeAg阳性慢性HBV感染者肝纤维化具有较好的预测价值,可为患者是否启动抗病毒治疗提供参考。

Objective To investigate the liver histopathological characteristics of HBeAg-positive chronic hepatitis B virus(HBV)infected patients with alanine aminotransferase(ALT)<2 times the upper limit of normal(2×ULN),and to study the correlations affecting the liver fibrosis staging factor.Methods Used a retrospective study,290 patients with HBeAg-positive chronic HBV infection with ALT<2×ULN who underwent liver biopsy in the Department of Infectious Diseases,the Affiliated Hospital of Yan′an University from October 2013 to August 2018 were selected.According to the pathological results,they were divided into two groups:mild liver fibrosis group(F 0-F 1)and obvious liver fibrosis group(F 2-F 4).Univariate and multivariate Logistic regression analysis were used to screen non-invasive clinical indicators that could assist in the diagnosis of liver fibrosis.Results Totally 290 patients were enrolled,including 219 cases in the mild liver fibrosis group and 71 cases in the obvious liver fibrosis group.Multivariate Logistic regression analysis showed that low HBsAg,high aspartate aminotransferase(AST)and liver stiffness value(LSM)were independent risk factors for obvious liver fibrosis.Conclusion HBsAg,AST and LSM have good predictive value for liver fibrosis in HBeAg-positive chronic HBV infected patients with ALT<2×ULN,and can provide references for patients to start antiviral therapy.