71例血清ALT正常的慢性HBV感染者临床与肝脏病理特征

目的 了解血清ALT正常的慢性HBV感染者的临床及肝脏病理特征.方法 分析71例血清ALT正常,且HBeAg阳性的慢性HBV感染者的年龄、性别、血清HBV DNA水平、肝脏病理改变等.结果 本组病例中＜30岁者61例(85.92%),≥30岁者10例(14.08%).45.07%感染者母亲HBsAg阳性,所有感染者血清HBVDNA为高水平复制,＞107copies/ml者占78.87%.95.77%感染者肝脏有轻度炎症反应,43.66%有不同程度的纤维化,未发现肝硬化.结论 血清ALT正常、HBeAg阳性的慢性HBV感染者多处于免疫耐受期,肝组织病理损害轻微,但部分患者肝脏有一定程度纤维化,显示ALT虽然正常,肝损伤可能在隐匿中进展.因此,对ALT正常的HBV感染者及早进行肝脏病理检查,有利于判断病情和确定治疗方案.

Hepatic pathology and clinical characteristics of 71 cases of chronic hepatitis B virus infection with normal serum ALT

Objective To investigate hepatic pathology and clinical features of chronic hepatitis B virus (HBV) infection with normal serum ALT. Method A total of 71 chronic HBV patients with normal serum ALT were involved in this study. Statistical analysis included age, sex, serum level of HBV DNA and hepatic pathological changes. Results In this study, 85.92% of patients were less than 30 years old, and 14.08% were 30 or over. The mothers of 45.07% of patients were HBsAg positive. High levels of serum HBV DNA were found in all patients and among whom 78.87% kept a HBV DNA level of more than 107 copies/ml.Among the patients, 95.77% had low-grade inflammation in liver, 43.66% had fibrosis at different grades, and none had cirrhosis. Conclusions Most of HBeAg positive chronic HBV patients with normal serum ALT are found in immune tolerant stage with mild pathological injuries. But a small number of patients have fibrosis, which suggests despite normalization of ALT, liver injury may be in progression. Therefore, hepatic pathological examination should be recommended in the patients chronically infected with HBV, which contributes to the understanding of disease state and selection of treatment regimen.