HBeAg阳性与HBeAg阴性慢性乙型肝炎患者的临床和病理对照

目的探讨HBeAg阳性与HBeAg阴性慢性乙型肝炎(CHB)患者的临床和肝组织病理损伤特点。方法经肝活检病理诊断为CHB患者548例,分为HBeAg阳性与HBeAg阴性2组,分别统计患者年龄、肝组织炎症活动度(G分级)、纤维化程度(S分期)、肝活检前后2周肝功能(ALB、GLB、TBil、ALT、AST、GGT)峰值、血清HBVDNA载量、肝组织病理改变与临床之间的关系。结果肝组织G分级、S分期与肝功能改变有相关性(P均0.01),肝功能明显异常者肝组织病理损伤亦重;S分期与G分级有相关性(P0.01),S分期随G分级升高而加重。HBeAg阳性者较HBeAg阴性者平均年龄小,ALT、AST水平及HBVDNA载量高(P均0.01)。HBeAg阴性者肝组织G分级、S分期与患者年龄有相关性(P均0.05),与HBVDNA载量有显著相关性(P均0.01);而HBeAg阳性者G分级、S分期与患者年龄、HBVDNA载量无相关性(P均0.05)。结论CHB肝功能改变可以反映肝脏病理损害程度,S分期随G分级升高而加重。HBeAg阳性与HBeAg阴性CHB患者临床表现有所不同:HBeAg阴性CHB患者年龄较大,ALT、AST水平及HBVDNA载量较低。除肝功能改变外,患者年龄、血清HBVDNA载量可作为HBeAg阴性CHB患者肝脏病变程度的预测指标。

Clinicopathological comparison of HBeAg positive and HBeAg negative patients with chronic hepatitis B

Objective To observe the characteristics of clinicopathological in HBeAg positive and HBeAg negative patients with chronic hepatitis B （CHB）.Methods All 548 patients with CHB diagnosed by liver biopsy pathology were divided into HBeAg positive and HBeAg negative groups in this study.Patients＇ ages,the grades of liver inflammation （G）,the stages of liver fibrosis （S）,ALB,GLB,TBil,ALT,GGT peak values and serum HBV DNA load 2 weeks before and after liver biopsy were evaluated and the relationships between pathological and clinical changes were investigated.Results The grades of liver inflammation and stages of liver fibrosis were significantly correlated with liver function changes （all P0.01）.Those with obviously abnormal liver function would suffer from a more serious hepatic pathological changes.The stages of liver fibrosis and grades of liver inflammation were positively correlated （P0.01）,and the stages of liver fibrosis became more serious with the rising of grades of liver inflammation.Average age of HBeAg positive patients was younger than that of HBeAg negative;ALT,AST and HBV DNA were higher （all P0.01）.The grades of liver inflammation and stages of liver fibrosis for HBeAg negative patients were related with ages （all P0.05） and HBV DNA load （all P0.01）.While the liver tissue changes in patients with HBeAg positive were not correlated with ages and HBV DNA load （all P0.05）.Conclusions The liver function of CHB patients were closely associated with the severity of hepatic pathological change,and the stages of liver fibrosis became more serious with the rising of grades of liver inflammation.But there were differences between HBeAg positive patients and HBeAg negative CHB patients.Patients with HBeAg negative were older than HBeAg positive patients,while ALT,AST and HBV DNA load were lower,which suggested that ages and HBV DNA load in serum are effective predicting factors for severity of hepatic pathological changes in CHB patients with HBeAg negative besides the changes of liver function.