低水平丙氨酸转氨酶慢性乙型肝炎病毒感染者肝组织学改变的危险因素分析

目的 了解低水平ALT慢性HBV感染者肝组织学改变的危险因素.方法 将2014年1月至2016年9月在浙江省人民医院行肝组织活检且ALT低于2倍正常上限值(ULN)的慢性HBV感染患者共321例纳入研究,根据肝脏组织学病变程度,分为有显著组织学改变组(217例)和无显著组织学改变组(104例),分析比较两组的性别、年龄、WBC、肝功能、HBeAg、HBV DNA等临床资料水平.通过Logistic回归筛选变量,建立回归模型,并绘制ROC曲线.结果 无显著组织学改变组的年龄为(35.14±9.35)岁,ALT、AST、γ-GT的中位数分别为29.00、25.00、19.00 U/L,均明显低于有显著组织学改变组(t=-3.214,P＜0.01;Z=-2.269,P＜0.05;Z=-4.596,P＜0.01;Z=-2.810,P＜0.01),而PLT为(197.09±64.44)×109/L,ALB、HBV DNA的中位数分别为45.25 g/L、5.16 lgIU/mL,高于有显著组织学改变组(t=2.777,P＜0.01;Z=3.148,P＜0.01;Z=2.387,P＜0.05).多因素分析显示,AST(OR=1.071,95％CI=1.043～1.100)、HBV DNA(OR=0.828,95％CI=0.743～0.923)两项因素可能与肝脏组织学改变有关.预测概率P绘制的ROC曲线下面积为0.714,诊断敏感性和特异性分别为63.13％和70.19％.结论 对于低水平ALT的HBV慢性感染者,AST和HBV DNA是肝脏组织学改变的独立危险因素.

Analysis on risk factors of liver histological change in chronic hepatitis B patients with low alanine aminotransferase level

Objective To investigate the risk factors of liver histological change in chronic hepatitis B patients with low ALT level.Methods A total of 321 chronic hepatitis B patients with ALT level 2 times lower than the upper limit of normal (ULN) who accepted liver biopsy in Zhejiang Provincial People's Hospital from January 2014 to September 2016 were enrolled,and were divided into significant histological change group (n=217) and non-significant histological change group (n=104).The clinical data including gender,age,WBC,liver function,HBeAg and HBV DNA were analyzed.Logistic regression was uesd to screen the multi-variables and build forecasting model.ROC curve was drawn based on the prediction probability.Results The age,the medians of ALT,AST and γ-GT in non-significant histological change group were (35.14±9.35) years old,29.00 U/L,25.00 U/L,and 19.00U/L,which were all obviously lower than significant histological change group (t=-3.214,P＜ 0.01;Z=-2.269,P＜0.05;Z=-4.596,P＜0.01;Z=-2.810,P＜0.01).While the level of PLT,the medians of ALB and HBV DNA were (197.09±64.44) ×109/L,45.25 g/L,5.16 lgIU/mL,which were all higher than significant histological change group (t=2.777,P＜0.01;Z=3.148,P＜0.01;Z=2.387,P＜0.05).Logistic regression showed that AST (OR=1.071,95％CI=1.043-1.100) and HBV DNA (OR=0.828,95％CI=0.743-0.923) may be related to significant liver histological change.The AUROC based on the prediction probability was 0.714 with the sensitivity and specificity of 63.13％ and 70.19％,respectively.Conclusions AST and HBV DNA are individual risk factors of significant liver histological change in the chronic hepatitis B patients with low ALT level.