摘要
目的探讨慢性乙型肝炎(CHB)患儿HBV DNA载量与肝脏病理及肝功能、肝纤维化血清学指标的关系。方法收集2010年7月-2015年6月湖南省儿童医院肝病中心收治的确诊为CHB的患儿79例,根据患儿血清HBV DNA载量分为低载量组(103拷贝/ml<HBV DNA载量≤105拷贝/ml,n=8)、中载量组(105拷贝/ml<HBV DNA载量≤107拷贝/ml,n=54)和高载量组(107拷贝/ml<HBV DNA载量,n=17),比较各组间肝脏病理变化程度及血清ALT、AST、Ⅲ型前胶原(PCⅢ)、层黏连蛋白(LN)、透明质酸(HA)、Ⅳ型胶原CⅣ水平。计量资料组间比较采用Kruskal-Wallis秩和检验,相关性分析采用Kendall's tau-b等级相关检验。结果 3组肝脏病理炎症程度分级均以G1为主,分别占75%、74.1%、64.7%,高载量组G2比例上升(35.5%);3组肝组织纤维化分期均以S1为主,分别占75.0%、72.2%、70.6%,低载量组出现S4(12.5%)。HBV DNA载量与肝组织炎症分级和纤维化分期均无相关性(r值分别为0.069、-0.047,P值均>0.05)。随着HBV DNA载量的增高,各组间血清ALT、AST水平逐渐增高,3组间ALT水平比较差异有统计学意义(χ2=5.37,P=0.048)。随着HBV DNA载量的增高,各组间血清HA、LN、PCⅢ和CⅣ水平则逐渐降低,3组间PCⅢ水平比较差异有统计学意义(χ2=6.26,P=0.044)。结论 CHB患儿HBV DNA载量与肝脏病理无显著相关性。临床综合分析HBV DNA载量及肝功能、肝纤维化血清学指标,结合肝活组织病理检查,才能更加客观、准确地评估CHB的病情。
Objective To investigate the correlation of HBV DNA load with liver pathology,liver function,and serological markers of liver fibrosis in children with chronic hepatitis B（ CHB）. Methods A total of 79 children with a confirmed diagnosis of CHB who were admitted to Liver Research Center of Children’s Hospital of Hunan Province from July 2010 to June 2015 were selected,and according to the serum HBV DNA load,they were divided into low load group（ 103〈 HBV DNA load≤105copies / ml,n = 8）,medium load group（ 105〈 HBV DNA load ≤107copies / ml,n = 54）,and high load group（ HBV DNA load 〉 107 copies / ml,n = 17）. The degree of liver pathological changes and serum levels of alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,procollagen type Ⅲ（ PC Ⅲ）,laminin（ LN）,hyaluronic acid（ HA）,and type Ⅳ collagen（ Ⅳ- C） were compared between the groups. The Kruskal- Wallis rank sum test was applied for comparison of continuous data between groups,and Kendall’s tau- b rank correlation analysis was applied for correlation analysis. Results The three groups mainly had a liver inflammation grade of G1,which accounted for 75%,74. 1%,and 64. 7%,respectively,and the high load group had an increased proportion of G2 patients（ 35. 5%）. The three groups mainly had a fibrosis stage of S1,which accounted for 75. 0%,72. 2%,and 70. 6%,respectively,and there were S4 patients in the low load group（ 12. 5%）. HBV DNA load was not correlated with liver inflammation grade or fibrosis stage（ r = 0. 069 and- 0. 047,both P 〉 0. 05）. The medium load group had higher serum levels of ALT and AST than the low load group,and the high load group had higher serum levels of ALT and AST than the medium load group; serum ALT level showed a significant difference between the three groups（ χ2= 5. 37,P = 0. 048）. The medium load group had lower serum levels of HA,LN,PCⅢ,and Ⅳ- C than the low load group,and the high load group had lower serum levels of HA,LN,PCⅢ,and Ⅳ- C
出处
《临床肝胆病杂志》
CAS
2016年第3期472-475,共4页
Journal of Clinical Hepatology
