摘要
目的分析ALT正常或轻度异常，即正常值上限（ULN）2倍以下（〈2×ULN），慢性HBV感染者的肝组织病理学改变及其影响因素，为其合理的临床诊治提供参考。方法对1148例ALT〈2×ULN慢性HBV感染者的肝组织炎症活动度分级（G）、纤维化分期（S）及临床资料进行分析，分为无治疗指征组（〈G2＋〈S2）638例和治疗指征组510例（其中≥G2＋≥s2组291例、≥G2单项组131例、≥s2单项组88例），根据年龄分为〈30岁组（359例）、30～40岁组（378例）和〉40岁组（411例）。计量资料采用方差分析，计数资料采用卡方检验，采用Logistic回归分析，并制作受试者工作特征曲线。结果患者多数有不同程度的病理损伤，≥G2或≥S2者占44．42％（510／1148）。治疗指征各亚组中男性（x2=9．319）和HBeAg阴性（x2=29．464）的构成、平均年龄（F=26．808）、ALT（F=34．827）及AST（F=49．643）的平均水平均高于无治疗指征组，而白蛋白／N蛋白（A／G，F=13．867）、白细胞计数（F=10．406）、血小板计数（F=52．570）的平均值均低于无治疗指征组，差异均有统计学意义（均P〈0．01），以≥G2＋≥S2组的改变最为显著。与治疗指征（G和S）相关的独立危险因素为血小板计数下降、AST升高、A／G下降、年龄增加、HBeAg状态（HBeAg阴性）及男性（均P〈0．05）。随着年龄的增长，肝脏炎症活动度和纤维化分期的严重程度加剧（x2值分别为32．154和44．585，均P〈0．01），以30岁以上显著，判断适合治疗指征（≥G2或≥S2）年龄的阳性截断值为32．5岁。结论较高比例的ALT〈2×ULN慢性HBV感染者依然存在明显的肝脏疾病进展，特别是32．5岁以上、HBeAg阴性并伴有血小板计数和A／G下降、AST升高趋势的男性患者。
Objective To analyze the liver pathology, clinical characteristics and influencing factors in chronic hepatitis B virus （HBV） infected patients with normal or slightly abnormal liver function alanice aminotransferase （ALT） less than two times of upper limits of normal （ULN） 〈2 × ULN, and to provide reference for reasonable clinical diagnosis and treatment. Methods The data of liver pathology [liver inflammation （G） and fibrosis stage （S）] and clinical characteristics of 1 148 cases were analyzed retrospectively. Patients were divided into non-treatment indication group （〈G2 ＋〈S2, 638 cases） and treatment indication group （510 cases, ≥G2＋ ≥S2 sub-group： 291 cases, ≥G2 sub-group; 131 cases, ≥S2 sub-group： 88 cases）, and were also divided into 〈30 years group （359 cases）, 30--40 years group （378 cases） and 〉40 years group （411 cases）, Measurement data were analyzed with variance analysis.Categorical data were analyzed with x2 test. Logistic regression analysis and receiver operating characteristic curve were also used. Results Patients with varying degree of pathological damage were enrolled. There were 510 cases （44.42%） with liver inflammation pathological grading ≥G2 or fibrosis stage ≥S2 in these 1 148 patients. The constituent ratios of male patients （x2 = 9. 319）, HBeAg negative （x2=29. 464）, the average age （F=26. 808）, and the average values of ALT （F= 34. 827） and AST （F= 49. 643） in each treatment indication sub-group were all higher than those in non-treatment indication group, while the average values of albumin-globulin ratio （A/G, F= 13. 867）, white blood cell （WBC, F= 10. 406） and platelet （PLT, F= 52. 570） were all lower. The differences were statistically significant （all P〈0.01）. The changes in ≥G2 ＋≥S2 sub group and the changes of PLT were the most significant. The independent risk factors of liver inflammation and liver exacerbation were PLT declining, AST rising, A/G declining,
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2016年第12期708-712,共5页
Chinese Journal of Infectious Diseases
基金
浙江省医药卫生省部培育计划项目（2014PYA018）
浙江省区域专病中心建设专科（感染科）项目（2014-98）
宁波市科技计划社发重大项目（2016C51005）
