摘要
目的探讨丙氨酸氨基转移酶(ALT)水平正常(≤40 U/L)的乙型肝炎病毒(HBV)e抗原(HBeAg)阳性的慢性HBV感染者的肝组织病理学特点,进一步研究影响肝组织炎性反应分级及纤维化分期的相关因素。方法185例ALT正常的HBeAg阳性慢性HBV感染患者作为研究对象,肝组织明显炎性反应者(A2~A3)29例,占15.7%;肝组织明显纤维化者(F2~F4)32例,占17.3%。回顾性分析纳入者的人口学、临床及病理学特征,应用单因素和多因素回归模型筛选影响肝组织明显炎性反应和纤维化的相关因素,并应用受试者工作特征(ROC)曲线评估其诊断价值。结果单因素和多因素回归分析结果显示,ALT和肝脏弹性测量值(LSM)是肝组织明显炎性反应的独立预测因素(HR=1.078、1.492,P=0.019、P<0.001);家族史、HBsAg和LSM是肝组织明显纤维化的独立预测因素(HR=4.398、0.343、1.308,P=0.023、0.022、0.008)。ALT、LSM在诊断肝组织明显炎性反应的ROC曲线下面积(AUC)分别为0.669、0.742(P<0.05);以ALT≥30.5 U/L为截断值,诊断肝组织明显炎性反应的灵敏度、特异度、准确度分别为55.2%、73.7%、67.9%;以LSM≥6.4 kPa为截断值,诊断肝组织明显炎性反应的灵敏度、特异度、准确度分别为51.7%、83.3%和75.4%。LSM在诊断肝组织明显纤维化的AUC为0.688(P<0.05);以血清LSM≥8.1 kPa为截断值,诊断肝组织明显纤维化的灵敏度、特异度、准确度为40.6%、92.8%和85.4%。结论在HBeAg阳性的慢性HBV感染的患者中,正常的ALT水平并不总是代表肝组织没有炎性反应及纤维化的存在;高ALT水平和高LSM是肝组织明显炎性反应的独立预测因素,有家族史、低HBsAg和高LSM水平是肝组织明显纤维化的独立预测因素;血清ALT水平与LSM能够较准确地诊断肝脏炎性反应程度,LSM能够较准确地诊断患者肝纤维化程度。
Objective To investigate the liver histopathological features in HBeAg-positive patients of chronic hepatitis B virus(HBV)infection with normal level of alanine aminotransferase(ALT≤40 U/L),and further analyze the influential factors of liver inflammation and fibrosis.Methods A total of 185 HBeAg-positive patients of chronic HBV infection with normal level of ALT were recruited in the study.There were 29 cases(15.7%)of significant liver inflammation(A2-A3),32 cases(17.3%)of significant fibrosis in liver tissue(F2-F4).The demographic,clinical and pathological data in patients were retrospectively analyzed.Univariate and multivariate regression models were used to screen the related factors of liver inflammation and fibrosis,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value.Results Univariate and multivariate regression analysis showed that ALT and liver stiffness measurement(LSM)were independent predictors of liver inflammation(HR=1.078,1.492,P=0.019,P<0.001).Family history,HBsAg and LSM were independent predictors of liver fibrosis(HR=4.398,0.343,1.308,P=0.023,0.022,0.008).The area under ROC curve of ALT and LSM in the diagnosis of liver inflammation was 0.669 and 0.742,respectively(P<0.05).When ALT≥30.5 U/L was taken as the cut off value,the sensitivity,the specificity and the accuracy of diagnosing significant inflammation were 55.2%,73.7%and 67.9%respectively.When LSM≥6.4 kPa was taken as the cut off value,the sensitivity,the specificity and the accuracy of diagnosing significant inflammation were 51.7%,83.3%and 75.4%respectively.The area under the ROC curve of LSM was 0.688(P<0.05).When LSM≥8.1 kPa was taken as the cut off value,the sensitivity,the specificity and the accuracy of diagnosing significant fibrosis were 40.6%,92.8%and 85.4%respectively.Conclusion Normal level of ALT do not always indicate the absence of histological inflammation and fibrosis in patients with HBeAg-positive of chronic HBV infection.The high levels of ALT and LSM were independent
作者
刘娜
张瑞芹
李春霞
东冰
周路路
张楠
徐光华
武琼
LIU Na;ZHANG Ruiqin;LI Chunxia;DONG Bing;ZHOU Lulu;ZHANG Nan;XU Guanghua;WU Qiong(Department of Infectious Diseases,the Affiliated Hospital of Yan′an University,Yan′an,Shaanxi 716000,China;Department of Gastroenterology,Yulin Second Hospital,Yulin,Shaanxi 719000,China)
出处
《检验医学与临床》
CAS
2020年第17期2471-2475,共5页
Laboratory Medicine and Clinic
基金
延安市科技惠民计划项目(HM2009-04)。
