乙型肝炎病毒携带者的肝脏病理学与临床特征

目的 研究HBV携带者的肝脏病理学与临床特征.方法 回顾性分析和比较58例慢性HBV携带者和32例非活动性HBsAg携带者年龄、性别、肝脏炎症及纤维化程度,并将患者按ALT水平分为低酶组(ALT≤20 U/L)34例和高酶组(20 U/L40岁)28例;并将58例慢性HBV携带者根据HBeAg阳性与否,分为HBeAg阳性组23例和HBeAg阴性组35例;分别对肝脏炎症及纤维化程度进行比较,两组连续变量间比较采用t检验,计数资料采用χ2检验. 结果 慢性HBV携带组与非活动性HBsAg携带组患者年龄分别为(24.7±4.8)岁和(35.2±7.6)岁,两组比较,t=2.576,P=0.017,差异有统计学意义,两组性别构成比比较,差异无统计学意义.肝纤维化程度非活动性HBsAg携带组SO期2例(6.2%),S1期7例(21.9%),≥S2期23例(71.9%),慢性HBV携带组S0期23例(39.6%),S1期20例(34.5%),≥S2期15例(25.9%),非活动性HBsAg携带组重于慢性HBV携带组,两组比较,χ2=23.231,P<0.01,差异有统计学意义.肝脏炎症程度比较,慢性HBV携带组与非活动性HBsAg携带组间差异无统计学意义.肝组织炎症程度:高酶组G1期26例(46.4%),≥G2期30例(53.6%),低酶组G1期26例(76.5%),≥G2组8例(23.5%),高酶组重于低酶组,两组比较,χ2=7.827,P=0.008,差异有统计学意义.肝纤维化程度:高酶组S0期10例(17.9%),S1期14例(25%),≥S2期32例(57.1%),低酶组S0期15例(44.1%),S1期13例(38.3%),≥S2期6例(17.6%),高酶组重于低酶组,两组比较,χ2=14.303,P=0.001,差异有统计学意义.肝组织炎症程度:高龄组G1期9例(32.1%),≥G2组19例(67.90),低龄组G1期43例(69.6%),≥G2组19例(30.4%),高龄组重于低龄组,两组比较,χ2=10.949,P=0.001,差异有统计学意义.肝纤维化程度:高龄组S0期1例(3.6%),S1期6例(21.40%),≥S2期21例(75%),低龄组S0期24例(38.8%),S1期21例(33.8%),≥S2期17例(27.4%),高龄组重于低龄组,两组比较,χ2=21.271,P<0.01,差异有统计学意义.慢性HBV携带者肝组织炎症程度:HBeAg阴性组Gl期14例(40%),≥G2组21例(60%),HBeAg阳性组G1期19例(82.6%),≥G2期4例(17.4%),HBeAg阴性组重于HBeAg阳性组,两组比较,χ2=10.275,P=0.002,差异有统计学意义,HBeAg阴性组肝纤维化程度与HBeAg阳性组比较,差异无统计学意义. 结论 对年龄较大、ALT接近正常及HBeAg阴性的慢性HBV携带者应推荐行肝活体组织学检查来指导临床诊断和治疗.

Relationship between liver pathology and clinical characters in HBV carriers

Objective To study the relationship between liver pathology and clinical characters of chronic HBV carriers. Methods Analyze the age, sex, grade of liver inflammation and stage of liver fibrosis among patients with chronic HBV carriers (n= 58) and non-active HBsAg carriers (n= 32), and compare the grade of liver inflammation and stage of liver fibrosis in different groups according to age, ALT levels and with/without HBeAg. The data was processed by using t test or χ2 test for statistical analysis, respectively. Results (1) No differences existed in gender composition ratio between chronic HBV carriers and non-active HBsAg carriers. However, the ages of non-active HBsAg carriers group (35.2 7.6) were much older than that of the HBV carriers group (24.7 + 4.8) (t= 2.576, P= 0.017). (2) The stage of liver fibrosis in non-active HBsAg carriers group was more aggravated than that of the chronic HBV carriers group ( χ2= 23.231, P < 0.01), whereas no significant differences existed between these 2 groups (χ2= 0.058, P= 0.972). (3) As tothe grade of liver inflammation and the stage of liver fibrosis, significant differences existed between the groups with higher level of serum ALT (20-40 U/L) and lower level (≤ 20 U/L)( χ2= 7.827, P= 0.008; χ2= 14.303, P= 0.001), and similar results also exsited between elder group (>40) and younger group (≤ 40)( χ2= 10.949, P= 0.001; χ2= 21.271, P < 0.01); (4) Among the chronic HBV carriers, significant differences existed in grade of liver inflammation between groups with HBeAg positive and negative patients ( χ2= 10.275, P= 0.002), and the latter was more aggravated; however, there was no difference in stage of liver fibrosis between them (χ2= 3.457, P= 0.178). Conclusions Liver histopathology can be recommended to guide the clinical diagnosis and treatment, especially for the chronic HBV carriers, with elder age, ALT close to normal and HBeAg negative.