ALT持续正常的慢性HBV感染者肝组织学特点分析

目的研究ALT持续正常的慢性乙肝病毒（HBV）感染者肝脏病理学改变。方法对184例ALT持续正常的慢性HBV感染者进行肝组织病理学检查,同时检测血清ALT水平、HBVDNA定量和HBV血清标志物,分别按ALT水平、性别、年龄、HBVDNA定量分组,比较各组肝脏炎症纤维化程度。结果慢性HBV携带者组均有不同程度的炎症、纤维化,≥G2期67例（44.08%）,≥S2期83例（54.61%）;非活动性HBsAg携带组≥G2期10例（31.25%）,≥S2期11例（34.38%）,两组肝脏炎症程度比较,差异无统计学意义（P〉0.05）;两组肝脏纤维化程度比较,慢性HBV携带组肝纤维化程度重于非活动性HBsAg携带组,差异有统计学意义（P〈0.05）。按ALT水平及性别不同分组,C组（30U/L〈ALT≤40U/L）肝脏炎症、纤维化程度均重于A组（ALT≤20U/L）,差异有统计学意义（P〈0.05）;同一ALT水平,女性肝脏炎症纤维化程度较男性有加重趋势,但差异无统计学意义（P〉0.05）。按年龄分组,30～39岁年龄组携带者有54.32%的患者肝脏纤维化程度≥G2期,≥40岁组肝脏炎症、纤维化情况重于〈20岁组,差异有统计学意义（P〈0.05）。按HBVDNA载量不同分组,各组肝脏炎症程度及纤维化程度差异均无统计学意义（P〉0.05）。结论几乎所有慢性HBV携带者的肝脏均有不同程度的炎症、纤维化,ALT持续正常的慢性HBV感染者年龄〉30岁、ALT≥30U/L（男性）、ALT≥20U/L（女性）患者应尽早行肝脏病理学检查,以指导临床及时对患者进行治疗。

Liver histopathological features of chronic hepatitis B virus infection with normal serum ALT

Objective To study liver histopathological feature of chronic hepatitis B virus infection with normal serum ALT.Methods Liver biopsies were performed on 184 chronic HBV infection with normal serum ALT value.The circulating HBVDNA loads and serologic markers of HBV were examined.The grade of liver inflammation and stage of liver fibrosis in different groups according to ALT levers,sex,age and serum HBVDNA level were analyzed.Results All chronic HBV carriers had histological liver changes.44.08% of them had severe liver inflammation,54.61% of them had severe liver fibrosis.The stage of liver fibrosis in chronic HBV carriers group was more aggravated than that of the non-active HBsAg carriers group,but there was no significant difference in the grades of liver inflammation between these two group.As to the grade of liver inflammation and the stage of liver fibrosis,significant differences existed between the groups with higher level of serum ALT（30～40 U/L）and lower level（≤20 U/L）,and similar results also exsited between elder group（40）and younger group（20）.No differences existed in the grades of liver inflammation and liver fibrosis among different serum HBVDNA level carriers（P〈0.05）.Conclusion All chronic HBV carriers had histological liver changes.Liver histopathology can be recommended to guide the clinical diagnosis and treatment,especially for the chronic hepatitis B virus infection with normal serum ALT value,with elder age（30）,ALT close to normal（ALT≥30U/L for male carriers,ALT≥20U/L for female carriers）.