血清低水平丙氨酸氨基转移酶的HBV感染者临床特征分析*

目的 分析总结低水平血清丙氨酸氨基转移酶(ALT)的HBV感染者临床特征,以利于寻找肝功能可能已经异常的线索。方法 2017年1月～2021年3月我院诊治的HBV感染者226例,均接受肝活检,采用Scheuer评分系统和组织学活动指数评价肝组织纤维化分期和炎症活动度分级。将肝组织炎症活动度分级和肝纤维化分期≥G2S2定义为显著肝组织学病变。结果 在本组226例HBV感染者中,临床诊断HBV携带者125例,慢性乙型肝炎(CHB)患者101例;CHB患者男性占比、显著肝组织病变、血清AST水平>40 U/L、肝纤维化分期≥F2和肝组织炎症活动度≥G2分别为77.2%、61.4%、49.5%、36.7%和52.5%,显著高于HBV携带者的54.4%、33.6%、5.6%、18.4%和25.6%(P<0.05);在226例HBV感染者中,经肝组织学检查,发现显著肝组织病变104例,非显著肝组织病变122例;显著肝组织病变患者血清HBV DNA水平为(4.6±1.2)lg copies/ml,显著低于非显著组【(5.2±1.4)lg copies/ml,P<0.05】,外周血血小板计数为(163.6±49.2)×10⁹/L,显著低于非显著组【(192.2±54.5)×10⁹/L,P<0.05】,血清ALT水平>40 U/L、AST水平>40 U/L、肝纤维化分期≥F2和肝组织炎症活动度分级≥G2占比分别为60.6%、39.4%、57.7%和81.7%,显著高于非显著组(分别为31.1%、13.1%、0.0%和0.0%,P<0.05)。结论 对于血清ALT低水平的HBV感染者应进行临床资料的筛查和甄别,其中一些已经存在肝组织学病变,适时进行肝活检可以帮助早期发现CHB患者而给予必要的处理,以改善预后。

Clinical features of chronic hepatitis B viral infected individuals with low serum alanine aminotransferase levels: clues for early liver biopsies

Objective The aim of this study was to summarize the clinical clues for early liver biopsies in chronic hepatitis B viral infected individuals with low serum alanine aminotransferase (ALT) levels. Methods 226 chronic hepatitis B viral infected individuals with low serum ALT levels were admitted to our hospital between January 2017 and March 2021,and all underwent liver biopsies. The liver injuries were evaluated by Scheuer scoring system for liver fibrosis staging and by histological activity index for inflammatory activity grading. The significant liver injuries were defined as the liver fibrosis≥S2 and/or the inflammatory activity≥G2. Results Out of the 226 individuals with HBV infection and low serum ALT levels, the clinical diagnosis was chronic HBV carriers in 125 cases, and chronic hepatitis B (CHB) in 101 cases; the percentages of male, significant liver injury, serum AST >40 U/L, liver fibrosis ≥F2 and liver inflammation ≥G2 in patients with CHB were 77.2%, 61.4%, 49.5%, 36.7% and 52.5%, all significantly higher than 54.4%, 33.6%, 5.6%, 18.4% and 25.6% in HBV carriers(P<0.05); out of the 226 individuals in our series, the liver histopathological examination showed significant liver injuries in 104 cases and non-significant liver injuries in 122 cases; serum HBV DNA load in patients with significant liver injury was(4.6±1.2) lg copies/ml, significantly lower than [(5.2±1.4)lg copies/ml, P<0.05], peripheral blood platelet count was (163.6±49.2)×10⁹/L, significantly lower than [(192.2±54.5)×10⁹/L, P<0.05] in individuals without significant liver injury, and the percentages of serum ALT level greater than 40 U/L, serum AST level greater than 40 U/L, liver fibrosis greater than F2 staging and liver inflammation greater than G2 grading were 60.6%, 39.4%, 57.7% and 81.7%, significantly higher than 31.1%, 13.1%, 0.0% and 0.0%, respectively (P<0.05) in individuals without significant liver injury. Conclusion The clinical feature of individuals with chronic hepatitis B viral infection and low serum ALT levels is subtle, and some clues might hint liver injury and warrant further liver biopsy, which could present the liver histopathological grading and staging and help the clinicians to make decisions.