慢性乙肝不同免疫自然史阶段肝脂肪变性程度与血清病毒学及肝脏病理的关系

Relationship between the degree of hepatic steatosis with serum virology and liver pathology in different immune natural history stages of chronic hepatitis B

目的探讨慢性乙肝(CHB)不同免疫自然史阶段肝脂肪变性程度与血清病毒学及肝脏病理的关系。方法选取2013年10月至2020年9月在浙江省人民医院行肝脏穿刺活检的175例CHB患者为研究对象,根据肝脂肪变性程度分为F_(0)~F_(1)组(无或轻度肝脂肪变性)122例和F_(2)~F_(4)组(中重度肝脂肪变性)53例,比较不同肝脂肪变性程度患者临床资料以及各免疫自然史阶段不同肝脂肪变性程度患者血清病毒学指标。结果175例CHB患者肝脂肪变性发生率为46.3%。F_(2)~F_(4)组患者BMI、高脂血症占比、血清HBs Ag水平均明显高于F_(0)~F_(1)组(均P<0.05);但两组患者年龄、Hb、PT、ALT、AST、ALP、谷氨酰转肽酶、抗病毒治疗占比、HBV DNA水平、HBe Ag水平以及免疫自然史比较,差异均无统计学意义(均P>0.05)。在免疫清除期,G_(3)~G_(4)或S_(0)~S_(2)时F_(2)~F_(4)组血清HBs Ag水平均明显高于F_(0)~F_(1)组(均P<0.05),G_(3)~G_(4)时F_(2)~F_(4)组血清HBe Ag水平明显高于F_(0)~F_(1)组(P<0.05);而G_(0)~G_(2)或S_(3)~S_(4)时不同肝脂肪变性程度患者血清病毒学指标比较,差异均无统计学意义(均P>0.05)。在免疫耐受期、免疫控制期、再活动期,各炎症及纤维化程度分期不同肝脂肪变性程度患者血清病毒学指标比较,差异均无统计学意义(均P>0.05)。结论在CHB不同免疫自然史阶段,仅发现免疫清除期随着肝脏炎症程度的加重,中重度肝脂肪变性患者血清HBsAg、HBeAg水平明显升高;而随着肝纤维化的加重,中重度肝脂肪变性患者血清HBsAg水平明显降低。

Objective To investigate the relationship of the degree of hepatic steatosis with serum virology and liver pathology in different immune natural history stages of chronic hepatitis B(CHB).Methods A total of 175 CHB patients who underwent liver biopsy in Zhejiang Provincial People's Hospital from October 2013 to September 2020 were enrolled in the study.According to the degree of hepatic steatosis,they were divided into F_(0)-F_(1) group(no or mild hepatic steatosis,n=122)and F_(2)-F_(4) group(moderate to severe hepatic steatosis,n=53).The relationship of degree of hepatic steatosis with serum virology and liver pathology at different immune natural history stages was analyzed.Results The incidence of hepatic steatosis was 46.3%.The BMI,proportion of hyperlipidemia and serum HBsAg level in F_(2)-F_(4) group were significantly higher than those in F_(0)-F_(1) group(all P<0.05).During the immune clearance period,the serum HBsAg level in F_(2)-F_(4) group was significantly higher than that in F_(0)-F_(1) group at G_(3)-G_(4) or S0-S2(P<0.05),and the serum HBeAg level in F_(2)-F_(4) group was significantly higher than that in F_(0)-F_(1) group at G_(3)-G_(4)(P<0.05).There was no significant difference in serum virological indexes between patients with different degrees of hepatic steatosis at G_(0)-G_(2) or S3-S4(all P>0.05).There was no significant difference in serum virological indexes among patients with different degrees of hepatic steatosis in immune tolerance stage,immune control stage and reactivation stage(all P>0.05).Conclusion The serum HBsAg and HBeAg levels in patients with moderate to severe hepatic steatosis increased significantly with the aggravation of liver inflammation in the immune clearance stage,while serum HBsAg levels in patients with moderate to severe hepatic steatosis decreased significantly with the aggravation of liver fibrosis.