慢性乙型肝炎病毒携带者的病理与临床及预后分析

目的了解慢性HBV携带者的肝脏组织病理与临床的关系,探讨其临床转归和影响预后的因素。方法对90例行肝穿刺活组织检查的慢性HBV携带者的临床和病理资料进行分析并持续随访观察。结果（1）90例患者平均随访时间118（29～260）周。（2）15例（16．7％）患者肝穿刺检查示无肝脏组织学病变,75例患者有炎症病变,其中G1期54例（60．0％）,G2期21例（23．3％）；肝纤维化分期S1期42例（46．7％）,S2期21例（23．3％）。（3）肝纤维化分期S2期的患者平均年龄为（45．9±16．4）岁,与S0期和S1期患者平均年龄[分别是（38．9±13．6）岁和（42．7±14．8）岁]相比较,差异有统计学意义（P＜0．05）。（4）炎症分级为G0期患者的血清ALT水平[（13．4±3．6）U/L]与G1和G2期患者的血清ALT水平[分别为（27．3±4．3）U/L和（31．8±7．2）U/L]相比较,差异有统计学意义（P＜0．05）。（5）肝组织炎症分级与HBeAg阳性与否及血清HBV DNA定量水平无关（P＞0．05）,肝组织纤维化分期与血清HBV DNA定量水平无关（P＞0．05）。纤维化程度高者以HBeAg阴性者为多,差异有统计学意义（P＜0．05）。（6）超声定量检查脾脏长度和厚度在肝纤维化分期S2期与S0、S1期患者比较,差异有统计学意义（P＜0．05）。（7）随访中60例血清ALT持续正常（A组）,22例血清ALT短暂升高（B组）,8例血清ALT持续升高（C组）。肝穿刺活组织检查时肝纤维化分期S2期患者所占百分比在A组和B组低于C组患者,但S0期患者所占百分比高于C组患者,差异有统计学意义（P＜0．05）。（8）年龄、肝纤维化分期是进展为肝硬化的独立预测因素。结论多数慢性HBV携带者肝脏组织学有轻度炎症,不伴有或伴有轻度肝纤维化,且肝纤维化随病程发展有不同程度进展。随访研究表明这些携带者中部分在近期内需要抗病毒治疗。

An analysis of the pathohistology of liver tissues, clinical features and prognostic factors of chronic hepatitis B virus carriers

Objective To study the correlations between clinical features and liver pathohistological changes of chronic hepatitis B virus (HBV) carders and to discuss the factors which may influence the prognosis. Methods Ninety HBV carders who had liver biopies were enrolled in this study.Results (1) The mean follow-up period of the patients was 118 weeks.(2) Fifty-four patients (60.0%) had G1 hepatitis and 21 (23.3%) had G2 hepatitis.The fibrosis stages were graded as S1(42) and S2(21).(3) There were significant age differ- ences among S0,S1 and S2 (P<0.05).(4) There were significant differences in aminotransferase levels between patients who had a normal liver histology and those who had mild hepatitis (P<0.05).(5) The grades of liver inflammation were not correlated with the titers of HBeAg and HBV DNA in sera.The stages of liver fibrosis were not correlated with the titers of HBVDNA in sera (P>0.05).Most of the HBeAg negative patients progressed to S2 (P<0.05).(6) There were significant differences in spleen dimensions measured by ultrosonography between S0,S1 and S2 patients (P<0.05).(7) During the follow-up period serum ami- notransferase (ALT) levels remained normal in 60 patients (group A);22 patients had transient elevations (group B),and 8 patients had persistant increases (group C).There were significant differences of the ratios of S0 and S2 cases among patients in groups A,B and C.(8) Age and fibrosis stages were predictive factors of liver cirrhosis.Conclusions Most chronic HBV carriers had mild inflammatory histological changes in their livers and also had different degrees of liver fibrosis.This follow-up study shows that some of those carriers should have had antiviral therapy.