慢性乙型肝炎患者ALT、HBV DNA及血清肝纤维化标志物与肝纤维化程度的关系

目的探讨ALT、HBV DNA以及血清纤维化标志物透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)与慢性乙型肝炎肝纤维化程度的关系。方法检测281例慢性乙型肝炎患者血清中ALT、HBV DNA和纤维化标志物(HA、LN、PⅢP及CⅣ)的水平,并行肝活检检测肝组织病理纤维化分期。结果 HBeAg阴性慢性乙型肝炎患者HBV DNA水平较低、纤维化程度较高。HBeAg阳性患者纤维化程度与HBV DNA呈负相关(r=-0.251,P<0.001),S≥3组水平最低。慢性乙型肝炎患者纤维化程度与PⅢP水平呈正相关,其水平随着纤维化程度的加重而明显升高。结论 PⅢP水平可能作为评估慢性乙型肝炎患者肝纤维化程度的血清学指标,血清HBV DNA与肝脏纤维化严重程度的关系仍需进一步深入探讨。

Correlation of ALT,HBV DNA,and serum markers of fibrosis with liver fibrosis in patients with chronic hepatitis B

Objective To investigate the relationship between levels of alanine aminotransferase(ALT),hepatitis B virus(HBV) DNA,hepatitis B virus e antigen(HBeAg),and serum fibrosis markers [(hyaluronic acid(HA),laminin(LN),type Ⅲ procollagen(PⅢP),and type IV collagen(CIV)] and severity of liver fibrosis in patients with chronic hepatitis B(CHB).Methods A total of 218 CHB patients were included in this study.Serum levels of ALT were measured by standard biochemical assay.HBV DNA was measured by quantitative PCR.Fibrosis markers(HA,LN,PⅢP,and CIV) were measured by radioimmunoassay.The severity of liver fibrosis was determined by histopathological examination of liver biopsy.Results HBeAg(-) CHB patients had a lower level of HBV DNA and a higher level of fibrosis than HBeAg(+) CHB patients.Liver fibrosis in the HBeAg(+) CHB patients was negatively correlated with HBV DNA level(r=-0.251,P<0.001),and the lowest level was found in patients with fibrosis stages ≥3.The severity of liver fibrosis in CHB patients was positively correlated with the serum levels of PⅢP,which continued to increase with severity during progressive development of liver fibrosis.Conclusion Levels of PⅢP may represent a useful serum marker of liver fibrosis severity.The relationship between HBV DNA and liver fibrosis requires further study for confirmation.