基于肝脏病理的慢性乙型肝炎患者危险因素分析及抗病毒治疗适应证探讨

Risk factors and antiviral treatment indications for chronic hepatitis B based on liver pathology

目的分析慢性乙型肝炎(CHB)患者肝脏炎症及纤维化进展的危险因素,为年龄<30岁CHB患者决策是否抗病毒治疗提供依据。方法收集2017年2月至2021年10月浙江树人大学树兰国际医学院附属树兰(杭州)医院收治的285例未行抗病毒治疗的CHB患者,记录肝脏穿刺病理结果、血液学指标及其他临床资料。根据炎症程度(G)、纤维化程度(S)分期(合称GS分期)分组,G≤1和S≤1患者纳为A组(123例),G>1和(或)S>1患者纳为B组(162例),比较两组患者血液学指标及临床资料,采用二元logistic回归分析影响CHB患者GS分期进展的危险因素,绘制ROC曲线评估相关风险因素对CHB患者肝脏GS分期进展的诊断效能。结果降低ALT阈值后ALT诊断肝脏GS分期进展的灵敏度升高,而特异度下降。两组年龄、WBC、PLT、白蛋白、ALT、AST、ALP、γ-谷氨酰转肽酶(γ-GT)、DBil、PT、国际标准化比值、透明质酸(HA)、Ⅳ型胶原(ⅣC)、基于ALT、AST、PLT和患者年龄的纤维化指数(FIB-4)比较,差异均有统计学意义(均P<0.05),二元logistic回归分析结果显示白蛋白、DBil、HA、ⅣC是CHB患者肝脏GS分期进展的危险因素(均P<0.05);ROC曲线显示HA、ⅣC诊断肝脏GS分期进展的AUC分别为0.616、0.655,白蛋白和DBil诊断肝脏GS分期进展的AUC无统计学意义。结论降低ALT阈值可提高诊断肝脏GS分期进展的灵敏度;对年龄<30岁CHB患者定期监测肝功能、肝纤维化指标、凝血功能等血液学指标,可有效评估其肝脏GS分期进展,有助于及时开启抗病毒治疗。

Objective To analyze the risk factors for liver inflammation and fibrosis progression in patients with chronic hepatitis B(CHB),and to provide the basis for initiating antiviral treatment for patients with CHB aged<30 years.Methods A total of 285 patients with CHB who were admitted to Shulan(Hangzhou)Hospital Affiliated to Shulan International Medical College of Zhejiang Shuren University and did not receive antiviral therapy were collected from February 2017 to October 2021.Liver biopsy pathology,hematological indexes and clinical information were recorded.According to the degree of inflammation(G)and fibrosis staging(S),the patients with G≤1 and S≤1 were divided into group A(123 cases),and those with G>1 and(or)S>1 were divided into group B(162 cases).The hematological indexes and clinical information of the two groups were compared.The risk factors for inflammation and fibrosis progression in patients with CHB were analyzed by binary logistic regression,and the diagnostic efficacy of related risk factors on liver GS stage of patients with CHB was evaluated by ROC curve.Results The sensitivity of the diagnosis of hepatic GS progression was significantly increased after lowering the ALT threshold,while the specificity was decreased.There were significant differences between the two groups in age,WBC,PLT,albumin,ALT,AST,ALP,γ-glutamyl transpeptidase(γ-GT),DBil,PT,international standardized ratio,hyaluronic acid(HA),typeⅣcollagen(ⅣC),and the FIB-4 index based on ALT,AST,PLT and age(all P<0.05).Binary logistic regression analysis showed that albumin,DBil,HA andⅣC were risk factors for liver GS progression in patients with CHB(all P<0.05);ROC curve showed that the AUCs of HA and IVC in diagnosing liver GS progression were 0.616 and 0.655,respectively,while the AUC of albumin and DBil showed no statistical significance in diagnosing liver GS progression.Conclusion Lowering ALT threshold can improve the sensitivity of diagnosis of liver GS progression.Regularly monitoring liver function,liver fibrosis index,coagulation function and other hematological indicators of patients with CHB younger than 30 years old can effectively evaluate the progression of liver GS,which is helpful to timely start antiviral treatment.