慢性乙型肝炎病毒携带者肝组织学特点与临床特征的关系

目的研究慢性HBV携带者的肝组织学特点与其临床特征的关系。方法对以“慢性HBsAg携带者”入院的142例患者行肝脏活体组织学检查,平均年龄（24．8±8．7）岁;其中129例血清HBV DNA阳性,符合“慢性HBV携带者”诊断,余13例符合“非活动性HBsAg携带者”诊断。肝穿刺获取标本（2．2±0．8）cm以进行组织学检查;同时进行血清病毒学、纤维化指标及蛋白质电泳、超声检查。按血清HBV DNA是否阳性及病理学诊断分组比较。结果病理学检查肝组织正常（G0S0）36例,慢性肝炎炎症分级≥G1和（或）纤维化分期≥S1]106例,其中包括早期肝硬化（G4S4）1例;按HBV DNA是否阳性分组比较,差异无统计学意义。血清HBV DNA均值为（7．58±0．99）log10拷贝／ml,HBeAg阳性123例。45．8％（49／107）γ-球蛋白增高;37．1％（23／62）血清纤维化指标增高;40．1％（57／142）彩色多普勒超声检查显示异常。按病理学诊断分组比较,慢性肝炎组的血清PCⅢ均值高于正常组（P〈0．05）;PCⅢ与炎症分级呈正相关（r=0．391, P〈0．01）。结论本组病例具有高病毒载量及炎症轻微的特征;组织学炎症分级、纤维化分期与HBV DNA水平及HlBeAg状态无相关性,血清PCⅢ增高与炎症分级有关。

A study on the hepatic histological changes and clinical manifestations in chronic HBV carriers

OBJECTIVE: To investigate the relationship between hepatic histopathological changes and clinical characteristics in chronic HBV carriers. METHOD: A retrospective analysis was performed based on the hepatic biopsy findings, clinical laboratory results, and ultrasound examinations in 142 chronic HBV carriers. The patients were divided into two groups according to their serum HBV DNA replication and the pathological alterations in their livers. RESULTS: The average age of the 142 patients was (24.8+/-8.7) years old. Among them, 129 were diagnosed as chronic HBV carriers based on their positive HBV DNA results. Thirteen were diagnosed as non-active HBsAg carriers. Hepatitis B family history was found in 31.0% of the cases. Normal liver tissues (G0S0) were found in the specimens of 33 cases (G > or = 1 and/or S > or = 1) chronic hepatitis B was diagnosed based on the biopsies in 106 cases, including an early stage of hepatic cirrhosis in 1 case (G4S4). There were no obvious differences between HBV DNA positive and negative group cases. The levels of HBV DNA in all the 129 cases of chronic HBV carriers were more than 1.0 x 10(4) copy/ml and the average value was (7.58+/-0.99) log10 copy/ml. Of the 129 cases, 123 were HBeAg positive (95.3%). Increased levels of gamma-globulin were detected in 45.8% of the cases and fibrosis index increased in 37.1%; 40.1% of the cases showed abnormalities in their ultrasound examinations. The average PCIII value of the chronic HBV carrier group (G > or = 1 and/or S > or = 1) was higher than that of the non-active HBsAg carrier group (P = 0.016). Spearman's analysis indicated that the inflammation grade (G) was correlated with the hepatic fibrosis index PCIII, and the correlation coefficient was 0.391 (P = 0.003). CONCLUSION: The patients in our study have a higher HBV DNA replication in their sera and have mild inflammation in their livers. Inflammation grade (G) and fibrosis stage (S) have no correlation with the level of HBV DNA or the state of HBeAg positivity. The increased level of PCIII might be related to their hepatic inflammation.