摘要
目的:对比谷丙转氨酶(alanine transaminase,ALT)<2倍正常值上限(upper limits of normal,ULN)的慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者中,乙型肝炎E抗原(hepatitis E antigen,HBeAg)阳性患者与HBeAg阴性患者肝组织病理学及临床改变的差异,并寻找这两部分患者中与肝组织学改变相关的因素.方法:将196例患者分为HBeAg阳性组与HBeAg阴性组,对比两组患者性别、年龄、血清ALT、HBV-DNA定量、脾脏厚度、门静脉内径、肝脏瞬时弹性探测仪(FibroScan)测定肝硬度值(1iver stiffness measurement,LSM)及病理检测肝脏炎症活动度、纤维化程度的差异,并进一步分析这两部分患者中,不同肝脏病理改变时上述临床资料的变化.结果:(1)HBeAg阳性患者为136例,肝脏炎症改变在G1-G2级,纤维化程度在S0-S2期,其中达G2、S2者分别为70例(51.5%)、14例(10.3%);HBeAg阴性患者为60例,肝脏炎症改变在G1-G3级,纤维化程度在S0-S2期,其中≥G2、达S2者分别为49例(81.7%)、19例(31.7%).HBeAg阴性患者的男性患者比例、年龄、血清ALT、HBV-DNA定量、LSM值及肝脏病变程度均明显高于HBeAg阳性患者,差异有统计学意义;(2)在HBeAg阳性患者中,随着肝脏炎症程度的加重,血清ALT、脾脏厚度、门静脉内径、LSM值明显增加,而性别比例、年龄、HBV-DAN定量无明显变化;随着肝脏纤维化程度的加重,脾脏厚度、门静脉内径、LSM值明显增加,而性别比例、年龄、血清ALT、HBV-DAN定量无明显变化;(3)在HBeAg阴性患者中,随着肝脏炎症及纤维化程度的加重,男性患者比例、年龄、脾脏厚度、门静脉内径、LSM值均明显增加,且血清ALT水平、HBV-DNA定量随肝脏炎症程度的加重亦明显增加,差异均有统计学意义,但以上两指标随肝脏纤维化程度的加重无明显变化.结论:对于ALT<2×ULN的慢性HBV感染者,HBeAg阴性患者的肝脏病变明显重于HBeAg阳性患者,在这两部分患者中,密切随访血清ALT、脾脏�
AIM： To compare hepatic histopathological changes and clinical features between HBeAg-positive and -negative patients with chronic hepatitis B virus （HBV） infection and mildly elevated alanine transaminase （ALT） level （less than two-time up limit of normal （ULN））, and to analyze factors affecting liver histology in the two groups.METHODS： One hundred and ninety-six patients were divided into an HBeAg-positive group and an HBeAg-negative group based on the HBeAg status. The sex ratio, age, serum ALT level, HBV DNA, thickness of spleen, breadth of portal vein, liver stiffness measurement （LSM） detected by Fibroscan, grade of liver inflammation and stage of liver fibrosis were compared between the two groups. Subsequently, the above clinical indexes were assessed among patients with different hepatic histopathological changes.RESULTS： There were 136 patients in the HBeAg-positive group. The grades of liver inflammation in this group were G1 and G2, and the stages of liver fibrosis were S0, S1 and S2. Seventy （51.5%） patients had G2 hepatitis and 14 （10.3%） patients had S2 fibrosis. There were 60 patients in the HBeAg-negative group. The grades of liver inflammation in this group were G1, G2 and G3, and the stages of liver fibrosis were S0, S1 and S2. Forty-nine （81.7%） patients had ≥ G2 hepatitis and 19 （31.7%） patients had S2 fibrosis. Compared to the HBeAg-positive group, the male patient’s ratio, age, serum ALT level, HBV-DNA level, LSM index and degree of liver inflammation and fibrosis in the HBeAg-negative group were obviously increased. In the HBeAg-positive group, serum ALT level, thickness of spleen, breadth of portal vein and LSM index were obviously increased with the aggravation of liver inflammation, although there were no obvious changes in the sex ratio, age and HBV DNA level. With the aggravation of liver fibrosis, the thickness of spleen, breadth of portal vein and LSM index were obviously increased, while there were no obvious changes in the sex ratio,
出处
《世界华人消化杂志》
CAS
北大核心
2013年第17期1607-1615,共9页
World Chinese Journal of Digestology
基金
中国肝炎防治基金会王宝恩肝纤维化研究基金资助项目
No.2010-xjs001
