147例ALT小于2倍正常上限的慢性乙型肝炎患者肝脏病理改变及相关因素分析

摘要

目的：了解ALT小于2倍正常值（ULN）CHB患者的肝脏病理特点，分析其与性别、年龄、病程、血清HBeAg状态、肝组织HBsAg和HBcAg的表达、ALT及HBV DNA水平的关系。方法采用回顾性分析方法，收集147例ALT ＜2 ULN的CHB患者的临床及病理资料，患者均行肝组织活检及免疫组织化学法检测肝组织中HBsAg和HBcAg表达。结果本研究纳入147例ALT＜2 ULN的CHB患者中，肝组织中重度炎症以上（≥ G2）者115例（78.2%），肝组织中重度纤维化以上（≥ S2）者80例（54.4%），其中S4者3例（2.1%）。不同性别、血清HBeAg状态、肝组织HBsAg和HBcAg表达患者之间肝脏炎症及纤维化程度无显著差异（P均＞0.05）。经Spearman等级相关分析显示，肝脏炎症分级与纤维化程度和年龄呈正相关（rs=0.566、0.185，P均＜0.05），与病程、ALT及HBV DNA水平差异均无统计学意义（P均＞0.05）；肝脏纤维化分期与年龄、ALT水平呈正相关（rs=0.317、0.227， P均＜0.05），与病程、HBV DNA水平差异均无统计学意义（P均＞0.05）。结论患者均有不同程度的组织学改变，对于ALT＜2 ULN，尤其年龄较大的患者，应尽早行肝组织病理学检查，对研究判断病情、指导抗病毒治疗具有十分重要的作用。%Objective To study the liver pathological changes in 147 patients of chronic hepatitis B with ALT less than two-fold up limit of normal and its correlation to sex, age, course of disease, HBeAg stage, the expression of HBsAg and HBcAg in liver tissue, the level of ALT and HBV DNA. Methods Retrospective analysis was used for 147 patients of chronic hepatitis B with ALT less than two-fold up limit of normal who accepted liver biopsy were included in this study. Immunohistochemistry was applied to detect the expression of HBsAg and HBcAg in liver tissues. Results Total of 147 patients of liver tissue inlfammation with two or more account for 78.2%, and patients of liver tissue ifbrosis with two or more account for 54.4%, including 2.1%of patients with S4. There were no statistical difference among different sex, HBeAg stage, the expression of HBsAg and HBcAg in liver tissue (all P>0.05). The grade of liver inlfammation was positively correlated with the stage of liver ifbrosis and the age, with correlation coefifcient as 0.566 and 0.185 (both P<0.05), respectively. There were no correlation with the degrees of liver inlfammation and the course of disease and the level of ALT and HBV DNA (all P>0.05). The stage of liver ifbrosis was positively correlated with the age and the level of ALT, with correlation coefifcient as 0.317 and 0.227 (both P<0.05), respectively. There were no correlation with the degrees of liver inlfammation and the course of disease and the level of HBV DNA (both P>0.05). conclusions All of 147 patients included in this study have different degrees of liver histological damage. The biopsy of liver is useful to judge the disease process and guide the remedy for the ALT<2 ULN especially in elder patients with CHB.