丙氨酸氨基转移酶低于2倍正常值上限的慢性乙型肝炎病毒感染者临床分析

目的：探讨丙氨酸氨基转移酶（ALT）低于2倍正常值上限（upper limits of normal,ULN）的慢性乙型肝炎病毒（HBV）感染者临床特征和肝组织病理学改变的关系.方法：将110例行肝活检的慢性HBV感染者按照ALT≤1×ULN和1 × ULN＜ALT＜2×ULN分成Ⅰ（n=64）、Ⅱ（n=46）组,分析其ALT水平、HBV DNA复制水平、年龄与肝组织病理学改变之间的相关性.结果：Ⅰ、Ⅱ组患者肝组织炎症活动度和纤维化程度差异均无统计学意义（P＞0.05）.2组中共有21.82％的患者肝组织炎症活动度≥G2级,29.09％的患者肝组织纤维化程度≥S2期,19.09％的患者肝组织学表现为肝硬化（S4期）.HBV DNA载量≥10 7（拷贝/ml）的患者年龄分布相对较年轻,肝组织的炎症和纤维化程度也相对较轻.共有81例予免疫组织化学染色法显示肝组织内乙型肝炎病毒表面抗原（HBsAg）和核心抗原（HBcAg）的表达,2组患者肝组织内HBsAg和HBcAg的免疫染色评分差异均无统计学意义（P＞0.05）.结论：慢性HBV感染者的临床生化和病毒学指标并不能完全反映肝脏病变的真实情况,对年龄较大的、病程较长的患者,无论ALT水平如何,均建议行肝活检,尤其可早期发现隐匿性肝硬化.

Clinical and liver histological analysis of chronic hepatitis B patients with alanine aminotransferase less than two-time upper limits of normal

Objective：To elucidate the relations of the clinical features and liver histological changes of chronic hepatitis B （HBV） patients with alanine aminotransferase（ALT） less than two-time upper limits of normal （ULN）. Methods：One hundred and ten cases with chronic HBV infection infection were divided into I group （ 64 cases） and 1I group （46 cases） according to the standard of ALT less than or equal to ALT≤1×ULN and1 × ULN〈ALT〈2×ULN less than ALT less than 2 x ULN, respectively. The relations of the levels of ALT and HBV DNA and age and liver histological changes in two groups were retrospectively analyzed. Results ： The difference of the histological grade of liver inflammation and fibrosis stage of liver in two groups was not statistical significance（ P 〉 0.05 ）. Among all cases, the histologic activity of liver inflammation more than or equal to grade 2 in 21.82%, the fibrosis stage of liver more than or equal to stage 2 in 29.09% and cirrhosis of liver in 19.09% （ stage 4） were found. The mean age of patients with HBV DNA more than or equal to 107（copies/m） was much younger, and their histological grade of liver inflammation and stage of fibrosis were relatively lower. The positive expressions of HBsAg and HBcAg in 81 cases liver tissue were detected by immunohistochemical staining, the differences of immunostaining scores of HBsAg and HBcAg between two groups were not statistical significance （ P 〉 0. 05 ）. Conclusions：The parameters of serological and virological testing in patients with chronic hepatitis B infection couldn＇t fully reflect the real situation of hepatic lesions. For the older patients with longer periods, liver biopsy should be detected regardless of their ALT levels, particularly for the patients with occult cirrhosis.