ALT持续正常的慢性HBV感染患者肝脏病理特点分析

目的分析ALT持续正常HBV感染患者的肝组织病理特点。方法选取感染科收治的146例ALT持续正常HBV感染患者,分析不同年龄、不同血清HBV-DNA载量和不同血清Hbe Ag状态下的肝组织炎症分级和纤维化分期特点。结果 40岁以上患者肝组织炎症分级≥G2比率以及纤维化分期≥S2比率均较40岁以下患者高(54.35%vs.8.00%,χ~2=38.688,P<0.001和45.65%vs.12.00%,χ~2=20.396,P<0.001);血清HBV-DNA载量>1.0×107copies/m L患者炎症分级≥G2比率以及纤维化分期≥S2比率均较血清HBV-DNA载量≤1.0×107copies/m L患者高(29.21%vs.12.28%,χ~2=5.695,P=0.017和30.34%vs.10.53%,χ~2=7.795,P=0.005);血清Hbe Ag(+)患者炎症分级≥G2比率以及纤维化分期≥S2的比率均较血清Hbe Ag (-)患者低(9.43%vs.30.11%,χ~2=8.248,P=0.004和13.21%vs.27.96%,χ~2=4.198,P=0.041),差异均有统计学意义。结论对于年龄≥40岁、血清HBV-DNA载量>1.0×107copies/m L以及Hbe Ag(-)的ALT持续正常慢性HBV感染患者,应及时进行肝穿刺病理检查,以免延误抗病毒治疗的最佳时机。

Analysis of liver pathological features in chronic HBV infection patients with persistently normal ALT

Objective To analyze the liver histopathological features in chronic HBV infection patients with persistently normal ALT. Methods A total of 146 chronic HBV infection patients with persistently normal ALT in our hospital were enrolled. The characteristics of liver tissue inflammation and fibrosis stage under different age groups, different serum HBV-DNA load and different serum HbeAg status were analyzed. Results The ratio of inflammatory grade≥G2 and the ratio of fibrosis stage≥S2 in patients over 40 years old were higher than those in patients under 40 years old (54.35% vs. 8.00%, χ2=38.688, P<0.001 and 45.65% vs. 12.00%, χ2=20.396, P<0.001); the ratio of inflammatory grade≥G2 and the ratio of fibrosis stage≥S2 in patients with serum HBV-DNA load>1.0×107 copies/mL were higher than those with serum HBV-DNA load≤1.0×107 copies/mL (29.21% vs. 12.28%, χ2=5.695, P=0.017 and 30.34% vs. 10.53%, χ2=7.795, P=0.005); the ratio of inflammatory grade≥G2 and the ratio of fibrosis stage≥S2 in patients with serum HBeAg (+) were lower than those with serum HBeAg (-) (9.43% vs. 30.11%, χ2=8.248, P=0.004 and 13.21% vs. 27.96%, χ2=4.198, P=0.041). The difference was statistical significant. Conclusion For the chronic HBV infection patients with persistent ALT, aged≥40 years old, serum HBV-DNA load>1.0×107 copies/mL and HbeAg (-), the liver biopsy should be performed in time to avoid the optimal timing of antiviral therapy.