丙氨酸氨基转移酶轻度升高慢性乙型肝炎患者肝组织病理学改变

目的分析ALT轻度升高的慢性乙型肝炎患者肝组织病理学改变情况,以探讨ALT水平与肝脏炎症及纤维化分期的关系。方法选择216例ALT轻度升高的慢性乙型肝炎患者及83例慢性HBV携带者,进行肝活检,分析肝脏炎症分级（G）及纤维化分期（S）与ALT及年龄的关系。结果在肝炎组中,炎症分级≥G2者占55.6%,明显高于对照组（31.3%）;肝炎组纤维化分期≥S2者占62.1%,也明显高于对照组（28.9%,P〈0.01）,均有显著性差异;在慢性肝炎组中年龄大于40岁者,肝组织炎症分级≥G2及纤维化分期≥S2者分别为69.5%及75.0%,均明显高于年龄〈40岁组,差异具有统计学意义（P〈0.01）;在年龄大于40岁的患者中,ALT〉60U/L者G3＋4比例（52.9%）高于ALT〈60U/L者（31.7%,P〈0.05）;ALT〉60U/L者纤维化分级高（S3＋4）者比例也明显高于ALT〈60U/L者,差异具有统计学意义（P〈0.05）,ALT〉60U/L组有84.3%纤维化分级≥S2,明显高于ALT〈60U/L组（63.4%,P〈0.05）。结论部分ALT轻度升高的慢性乙型肝炎患者肝组织病变也处于活动期,其中年龄大于40岁而ALT又大于60U/L者,应开始抗病毒治疗,达不到这个标准的患者应行肝组织活检来决定是否需要抗病毒治疗。

Pathohistological change of hepatic biopsies in chronic hepatitis B patients with mild ALT elevation

Objective To analyze the hepatic pathohistology of biopsies in chronic hepatitis B patients with mild ALT elevation.Methods 216 liver biopsies from patients with chronic hepatitis B with ALT elevation(lower than two times upper limits of normal) and 83 with asymptomatic HbsAg carriers(ASC) were included for liver biopsies.Results 55.6% and 62.1% of patients with CHB had G2 or S2,respectively,much higher than those in the ASC group(P<0.01);The greater than G2 or S2 in patients with CHB over the age of 40 years were 69.5% or 75.0%,respectively,much higher than in patients younger than 40 years;In patients with chronic hepatitis B and with the age over 40 years,52.9% had G3 to G4 in those with ALT greater than 60u/L,much higher than 31.7% in patients with the ALT lower than 60U/L;The fibrosis above S2 staging was 84.3% in patients with ALT greater than 60U/L,much higher than that in patients with ALT lower than 60U/L.Conclusion Part of patients with CHB with mild ALT elevation have liver pathological changes.The patients over the age of 40 years and ALT higher than 60U/L should receive antiviral treatment.