摘要
目的：探讨HBeAg阴性的慢性乙型肝炎（CHB）患者的肝脏病理特点及其相关因素。方法：选择134例符合抗病毒治疗条件的HBeAg阴性的CHB患者，行肝穿刺活检，常规苏木素一伊红染色及嗜银染色后．采用改良的Knodell HAI评分系统进行病理分析，并检测患者血清中丙氨酸氨基转移酶（ALT）、HBVDNA、乙型肝炎血清标志物以及乙型肝炎病毒基因型。均数比较采用t检验和方差分析，非参统计采用Kruskal—Wallis检验．用多元线性回归方法分析与肝脏炎症活动和纤维化相关的因素。结果：134例HBeAg阴性CHB患者炎症活动指数（HAI）按轻度（4～8分）、中度（9～12）和重度（13～18）炎症分组，3组中病例数分别为36例（26．9％）、35例（26．1％）、63例（47．0％）。纤维化评分〈3分和≥3分的病例数分别为25例（18．7％）和109例（81．3％）。患者血清ALT水平和肝脏纤维化是肝脏炎症活动度的相关因素（t=6．687，P〈0．01；t=3．478，P〈0．01）；而患者年龄和肝脏炎症活动度是肝脏纤维化的相关因素（t=3．587，P〈0．01：t=7．136．P〈0．01）。患者性别、乙型肝炎病毒载量、乙型肝炎病毒基因型和HBeAb状态与肝脏病理改变无明显相关。结论：本研究HBeAg阴性的CHB患者中，肝脏病理改变以中、重度肝炎居多，患者血清ALT水平越高．肝脏炎症活动越重，患者年龄越大，肝脏纤维化程度越重。
Objective To investigate hepatic histological features and its influencing factors of HBeAg- negative chronic hepatitis B patients. Methods 134 HBeAg-negative chronic hepatitis B （CHB） patients who underwent percutaneous liver biopsy were recruited in this study. The liver biopsy sections were examined after routine haematoxylin-eosin （HE） staining, and silver staining for assessment of fibrosis. The activity of liver disease was assessed by using a modified Knodell numeric histology activity index （HAI）. ALT level, HBV DNA load, HBV serological markers, HBV genotype were assessed with appropriate methods, t test or analysis of variance was used to compare means. Non-parametric was done by Kruskal-Wallis test. The correlation between liver pathological change and clinical factors was analyzed by multivariate linear regression. Results Of 134 HBeAg negative CHB patients, percentages of mild （HAI 4 - 8）, moderate （HAl 9 - 12）, and severe hepatitis （HA1 13 - 18） were 26.9%, 26.1%, and 47.0%, respectively. As for hepatic fibrosis, 18.7% and 81.3% of the patients had fibrosis score 〈 3 and ≥ 3, respectively. Multivariate regression analysis showed that ALT level and hepatic fibrosis were correlated to hepatic inflammation （t = 6.687,P 〈 0.01; t = 3.478, P 〈 0.01） while age and hepatic inflammation activity were influencing factors of hepatic fibrosis （t = 3.587, P 〈 0.01; t = 7.136, P 〈 0.01）. However, correlation is not significant between hepatic histological change and other factors, including gender, HBVDNA, HBV genotype and HBeAb status. Conclusions In this study, hepatic histological change tend to become worse in majority of HBeAg-negative chronic hepatitis B, especially in older patients and those with high ALT level.
出处
《实用医学杂志》
CAS
北大核心
2015年第16期2626-2630,共5页
The Journal of Practical Medicine
基金
南方医科大学南方医院院长基金项目(编号:2014B022)
关键词
肝炎
乙型
慢性
肝脏病理
HBe抗原
Hepatitis B, chronic
Hepatic histology
Hepatitis B e antigen
