HBeAg阳性ALT正常不确定期患者肝组织纤维化程度及影响因素分析

The degree and influencing factors of liver fibrosis in patients with chronic hepatitis B in the grey zone with hbeAg-positive and normal ALT

目的:分析乙型肝炎e抗原(HBeAg)阳性丙氨酸氨基转移酶(ALT)正常不确定期患者肝脏组织纤维化程度,为HBeAg阳性ALT正常不确定期患者的病情判断提供依据。方法:选取2017年1月至2021年12月HBeAg阳性ALT正常乙型肝炎病毒载量(HBV DNA)水平低于2×10^(7)IU/ml且高于20 IU/ml者作为研究对象,对该类患者进行肝组织病理学检查,并收集患者年龄、性别、感染HBV时间、肝功能、乙型肝炎表面抗原(HBsAg)水平、HBV DNA载量、基因型、门静脉内径、脾静脉内径、脾脏厚度等,Logistic回归分析患者肝组织纤维化的影响因素,受试者工作特征(ROC)曲线及相关参数评价其效能。结果:178例患者中,Scheuer法分期:S0期6例(3.4%),S1期67例(37.6%),S2期83例(46.6%),S3期14例(7.9%),S4期8例(4.5%),纤维化程度≥S2期105例(59.0%)。Logistic回归分析肝组织显著纤维化与感染时间(OR=1.101,95%CI=1.000~1.212;P=0.049)、HBV DNAlg(OR=1.280,95%CI=1.023~1.600;P=0.031)、门静脉内径(OR=1.611,95%CI=1.100~2.360;P=0.014)和脾脏厚度(OR=1.276,95%CI=1.107~1.469;P=0.001)独立相关,ROC曲线下面积(AUC)分别为0.67、0.62、0.70、0.67,天门冬氨酸氨基转移酶/血小板(APRI)和肝纤维化4因子指数(FIB-4)的AUC分别为0.68、0.57。结论:HBeAg阳性ALT正常不确定期患者中,有相当比例的患者纤维化程度≥S2,具有抗病毒治疗的指征。感染时间、HBV DNA、门静脉内径和脾脏厚度可能对预测其肝组织显著纤维化有一定的临床价值。

Objective:To analyze the degree of liver fibrosis in hepatitis Be antigen(HBeAg)-positive patients with uncertain normal alanine aminotransferase(ALT),and to provide a basis for the judgment of the condition of HBeAg positive patients with uncertain normal ALT.Methods:From January 2017 to December 2021,the patients with HBeAg positive normal ALT HBV DNA level of lower than 2×10^(7) IU/ml and higher than 20 IU/ml were taken as the research objects.Liver histopathological examination was performed,and the patients′age,gender,HBV infection time,liver function,HBsAg level,HBV DNA load,genotype,portal vein diameter,splenic vein diameter,spleen thickness were collected.Logistic regression was used to analyze the influencing factors of significant fibrosis,and receiver operator characteristic(ROC)curve was used to evaluate its efficacy.Results:Among 178 cases,there were 6 cases of S0(3.4%),67 cases of S1(37.6%),84 cases of S2(46.6%),14 cases of S3(7.9%)and 8 cases of S4(4.5%).105(59.0%)with fibrosis degree≥S2.Logistic regression analysis showed that significant liver fibrosis was independently correlated with infection time(OR=1.101,95%CI:1.000~1.212;P=0.049),HBV DNAlg(OR=1.280,95%CI=1.023~1.600;P=0.031),portal vein(OR=1.611~95%CI=1.100~2.360;P=0.014)and spleen thickness(OR=1.276~95%CI=1.107~1.469;P=0.001),the area under curve of ROC was 0.67,0.62,0.70 and 0.67 respectively,and 0.68 and 0.57 of aminotransferase to platelet ratio index and fibrosis 4 score.Conclusion:A substantial segment of patients who were hbeAg-positive and possess indeterminate ALT levels exhibited a fibrosis stage of≥S2,necessitating the initiation of antiviral treatment.The duration of infection,levels of HBV DNA,the diameter of the portal vein,and the thickness of the spleen might possess some clinical significance in forecasting the presence of notable liver fibrosis.