慢性乙型肝炎236例肝组织病理分析

目的探讨不同年龄段不同HBeAg状态的慢性乙型肝炎患者肝组织炎症及纤维化程度。方法以236例在我院做过肝穿刺活体组织检查术（肝活检）、ALT〈2倍正常值上限（upper limit of normal，ULN）的慢性乙型肝炎患者为研究对象，分为HBeAg阳性组123例，HBeAg阴性组113例，各组所有病例按年龄段分为3组：年龄〈30岁组，30～40岁组，340岁组。分析不同年龄段不同HBeAg状态与肝组织病理炎症及纤维化程度的关系。结果相同HBeAg状态患者，年龄越大，肝组织炎症及纤维化程度越重；相同年龄段，HBeAg阴性患者肝组织炎症及纤维化程度重。结论HBeAg阴性、高年龄段（≥40岁）、ALT〈2×ULN的慢性乙型肝炎患者肝组织病理改变程度较重。这些患者若无条件行肝活检，可以考虑直接抗病毒治疗。

Pathological analysis of liver tissues in 236 patients with chronic hepatitis B

Objective To evaluate the degrees of liver inflammation and fibrosis in different age groups of patients with chronic hepatitis B（CHB） in different HBeAg status. Methods Of 236 CHB patients with ALT levels less than 2 times the upper limit of normal （ULN）, 123 were HBcAg-positive （HBeAg-positive group） and 113 HBeAg-negative （HBeAg-negative group）. In each group, the patients were divided into 3 subgroups according to the age： 〈30 years group, 30-40 years group and ≥40 years group. The correlation of different age groups of CHB patients in different HBeAg status and the degrees of liver inflammation and fibrosis was analyzed. Results Patients with the same HBeAg status in older age groups had more severe degrees of liver inflammation and fibrosis. HBeAg-negative patients had more severe degrees of liver inflammation and fibrosis compared to HBeAg-positve patients in the different age groups. Conclusions HBeAgnegative CHB patients with ALT levels less than 2 times ULN at older age（≥40 years） have more severe degrees of pathological changes in the liver tissues. If the liver biopsy cannot be undertaken in these patients, antiviral therapy should be recommended.