220例血清HBV DNA≤2000 IU/mL的代偿期肝硬化患者肝功能评价指标、并发症分析

Analysis of liver function evaluation indices and complications in 220 compensated cirrhosis patients with serum HBV DNA≤2000 IU/mL

目的了解血清乙型肝炎病毒(HBV)DNA≤2000 IU/mL的乙型肝炎病毒(HBV)相关代偿期肝硬化患者的肝功能及并发症发生情况,为后续临床诊疗提供依据。方法220例血清HBV DNA≤2000IU/mL的HBV相关代偿期肝硬化患者,收集其肝功能评价指标资料和并发症资料。结果220例患者肝功能生化指标血清甲胎蛋白为4.80(2.12,8.35)ng/mL、总胆红素为18.90(14.10,28.76)μmol/L,白蛋白为39.35(34.60,43.90)g/L、肌酐为64(56,73.52)μmol/L、丙氨酸转氨酶为31.73(21.12,52.17)U/L、天冬氨酸转氨酶为30.35(23.85,48.85)U/L、γ-谷氨酰转肽酶42.70(24,66.08)U/L、碱性磷酸酶为82.05(63.38,113)U/L、血小板为105(57.25,158)×109/L、凝血酶原活动度为81.03%(66%,93.97%)、国际标准化比值为1.09(1.02,1.21);肝功能CTP分级以A级为主,终末期肝病模型评分(8.91±3.78)分、天冬氨酸转移酶及血小板比率指数(1.63±2.83)分、基于4因子的肝纤维化指数评分(4.84±5.28)分。220例患者中HBV DNA阳性(血清HBV DNA 100~2000 IU/mL)49例、乙肝表面抗原阳性183例、乙肝e抗原阳性151例。220例患者并发症发生情况为脾大103例、脾功能亢进110例、食管胃底静脉曲张74例、门静脉血栓6例、HCC 6例。与其他年龄比较,年龄<40岁的HBV相关代偿期肝硬化患者脾大发生率高(χ^(2)=6.864,P<0.05)。结论虽然血清HBV DNA≤2000 IU/mL的代偿期HBV相关肝硬化患者的肝功能基本正常,但部分指标处于正常范围的低值。血清HBV DNA≤2000 IU/mL的代偿期HBV相关肝硬化患者脾大、脾功能亢进等并发症发生率较高。

Objective To understand the liver function and the occurrence of complications in patients with hepati⁃tis B virus(HBV)-related compensated cirrhosis with serum hepatitis B virus(HBV)DNA≤2000 IU/mL and to pro⁃vide a basis for subsequent clinical management.Methods Information on liver function evaluation indexes and com⁃plications was collected from 220 HBV-related compensated cirrhosis patients with serum HBV DNA≤2000 IU/mL.Results Among the biochemical indexes of liver function in 220 patients,serum alpha-fetoprotein was 4.80(2.12,8.35)ng/mL,total bilirubin was 18.90(14.10,28.76)μmol/L,albumin was 39.35(34.60,43.90)g/L,creatinine was 64(56,73.52)μmol/L,alanine aminotransferase was 31.73(21.12,52.17)U/L,aspartate aminotransferase was 30.35(23.85,48.85)U/L,γ-glutamyl transpeptidase was 42.70(24,66.08)U/L,alkaline phosphatase was 82.05(63.38,113)U/L,platelets were 105(57.25,158)×109/L,prothrombin activity was 81.03%(66%,93.97%),and in⁃ternational normalized ratio was 1.09(1.02,1.21).CTP classification of liver function was predominantly grade A.The model score for end-stage liver disease was 8.91±3.78,the aspartate transferase and platelet ratio index was 1.63±2.83,and the 4-factor-based liver fibrosis index score was 4.84±5.28.Complications in 220 patients were splenomegaly in 103,hypersplenism in 110,esophagogastric fundic varices in 74,portal vein thrombosis in 6,and HCC in 6.The inci⁃dence of splenomegaly was higher in HBV-related compensated cirrhosis patients aged<40 years in comparison with other ages(χ^(2)=6.864,P<0.05).Conclusions Although liver function was essentially normal in HBV-related compensated cirrhosis patients with serum HBV DNA≤2000 IU/mL,some indicators were in the low end of the normal range.HBV-related compensated cirrhosis patients with serum HBV DNA≤2000 IU/mL have a higher incidence of complications such as splenomegaly and hypersplenism.