肝功能正常的慢性乙型肝炎病毒感染者血清HBeAg及HBV DNA与肝组织病理改变的关系

目的了解肝功能正常的慢性乙型肝炎病毒（HBV）感染者肝组织病理改变特征,并分析血清HBeAg及HBV DNA定量与肝组织病理改变的关系。方法选取肝功能正常的慢性HBV感染者90例,行肝穿刺病理检查,依据血清HBeAg及HBV DNA将患者分组,分别比较HBeAg阳性和阴性组及HBV DNA阳性和阴性组患者肝组织炎症分级和纤维化分期结果。结果90例患者100%存在肝组织损伤,其中肝硬化8例（8.9%）;慢性乙型肝炎轻度62例（68.9%）,中度8例（8.9%）,重度12例（13.3%）。82例病理诊断慢性乙型肝炎的患者中,炎症分级G≥2者30例（36.6%）;纤维化分期S≥2者28例（34.15%）。HBeAg阴性组病理炎症分级及纤维化分期均明显重于阳性组（P值均〈0.05）。HBV DNA阴性和阳性组肝组织炎症分级和纤维化分期差异均无统计学意义。结论肝功能正常的慢性HBV感染者,肝组织病理皆非＂正常＂;血清HBeAg、HBV DNA均不能反映肝脏损伤情况;对此类患者制定治疗方案时应考虑肝组织病理检查结果。

The relationship between serum HBeAg, HBV DNA and liver pathological change in chronic hepatitis B virus carriers with normal liver function

Objective To explore the relationship between serum HBeAg, the qualification of HBV DNA and the histopathologic change of livers in chronic hepatitis B virus carriers with normal liver function. Methods Liver biopsy, serum and serological examination were performed in 90 randomly selected chronic hepatitis B virus carriers with normal liver function. Groups were divided based on serum HBeAg and HBV DNA levels. Comparisons of liver inflammation and fibrosis stages were conducted between groups. Results All of the 90 subjects had liver injury. Eight cirrhosis （8.9%）, 62 slight CHB （68. 9%）, 8 moderate CHB （8. 9%） and 12 severe CHB （13.3%） were detected. Among 82 patients pathologically diagnosed as CHB, 30 （36.6%） had inflammation stage G≥2, 28 （34.15%） had fibrosis stage S≥2. The inflammation and fibrosis stages in HBeAg negative group were more severe than HBeAg positive group （P〈0.05）. No significant differences were observed in the inflammation and fibrosis stages between HBV DNA positive/negative groups. Conclusion The chronic HBV carriers with normal liver function may have pathologically liver injuries. Serum HBeAg and HBV DNA are unable to reflect the real condition of liver injury. Liver pathological results should be considered before a treating plan was chosen.