ALT轻度升高的慢性乙型肝炎患者肝脏组织病理学特征分析

目的分析ALT轻度升高的慢性乙型肝炎(CHB)患者的肝组织病理学状态与临床关系,为抗病毒治疗提供依据。方法回顾性分析105例ALT轻度升高的CHB患者的肝脏组织病理学情况,根据肝组织不同炎症及纤维化分组,对比各组性别、年龄、ALT、HBV-DNA水平、HBeAg状态差异。结果 105例患者均存在不同程度的炎症活动,其中80%(84/105)为G2^G4;67.6%(71/105)存在不同程度的纤维化,其中46.6%(49/105)为S2G4;67.6%(71/105)存在不同程度的纤维化,其中46.6%(49/105)为S2^S4。不同肝组织炎症分级间性别、年龄、HBV-DNA水平、HBeAg状态比较均无统计学意义(P>0.05);不同纤维化分期间年龄比较,S1、S3、S4组与S0组差异具有统计学意义(P<0.05),性别、ALT、HBV-DNA水平、HBeAg状态在各组间比较无统计学意义(P>0.05)。结论 ALT轻度升高的CHB患者可能存在明显的肝组织病理学改变,应积极考虑行肝穿刺活检,及时确定抗病毒治疗时机。

Liver histopathology characteristics analysis of chronic hepatitis B with mild elevation of alanine aminotransferase

Objective To study the liver histological changes in chronic hepatitis B（CHB） patients with mild elevation of serum alanine aminotransferase （ALT） and the related clinic factors, providing basis for antiviral therapy.Methods 105 CHB patients with mild elevation of ALT were included in this study. Their liver histological changes and the relationship between these changes and gender, age, HBV-DNA level, HBeAg status of patients were retrospectively analyzed.Results Among 105 patients, 100% （105/105） had different degrees of inflammation, 80% （84/105） were G2-G4; 67.6% （71/105） had different degrees of fibrosis, 46.6% （49/105） were S2-S4. There were no significant differences between different grades of inflammation in patients with gender, age, ALT level, HBV-DNA level, HBeAg status. Age increased as the stage of fibrosis increased, and there were significant differences between S1, S3, S4 and S0. But there were no significant differences between different stages of fibrosis in patients with gender, ALT level, HBV-DNA level, HBeAg status.Conclusion There may be obvious change of liver histopathology in CHB patients with mild elevation of ALT, who should be considered for liver biopsy, in order to determine the timing of antiretroviral therapy without delay.