中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2012年
5期
348-352
,共5页
刘顺庆%朱晓骏%孙学华%李曼%高月求
劉順慶%硃曉駿%孫學華%李曼%高月求
류순경%주효준%손학화%리만%고월구
肝炎,乙型,慢性%肝炎e抗原,乙型%丙氨酸转氨酶%病理学
肝炎,乙型,慢性%肝炎e抗原,乙型%丙氨痠轉氨酶%病理學
간염,을형,만성%간염e항원,을형%병안산전안매%병이학
Hepatitis B,chronic%Hepatitis B e antigens%Alanine transaminase%Pathology
目的 分析ALT轻度升高(1～2倍正常值上限)的HBeAg阳性和阴性慢性乙型肝炎患者肝组织病理学特点,并探讨年龄及HBV DNA水平对其的影响.方法 收集2009年10月至2011年3月,“十一五”国家科技重大专项——慢性乙型肝炎中西医结合治疗方案入组病例中符合条件者,行B超引导下肝穿刺活组织检查,并检测HBsAg、HBeAg滴度及HBV DNA水平.比较HBeAg阳性和阴性患者炎症分级和纤维化分期情况及年龄(≥40岁和＜40岁)、HBVDNA水平(≥105拷贝/ml和＜105拷贝/ml)对其的影响.两样本构成比的比较用x2检验,相关性分析用多因素logistic回归分析.结果 389例HBeAg阳性与126例HBeAg阴性患者的肝组织炎症分级与纤维化分期分布差异均无统计学意义(x2值分别为4.326和3.464,P值均＞0.05).＜40岁组中,HBeAg阳性与阴性患者的炎症分级及纤维化分期分布差异无统计学意义(x2值分别2.543和5.024,P值均＞0.05).≥40岁组中,HBeAg阳性患者中、重度炎症(G3、G4)所占百分比(32.9％)明显高于HBeAg阴性者(16.4％),x2=8.777,P＜0.05;纤维化分期分布差异无统计学意义(x2=0.977,P＞0.05).HBV DNA≥105拷贝/ml患者中,HBeAg阳性患者轻度炎症(Gl)所占百分比(17.5％)明显高于HBeAg阴性患者(7.3％),x2=8.851,P＜0.05;HBeAg阳性和阴性患者肝组织纤维化分期分布差异无统计学意义(x2=8.227,P＞0.05).HBVDNA＜105拷贝/ml的患者中,HBeAg阴性患者轻度炎症(Gl)所占百分比(29.6％)明显高于HBeAg阳性患者(6.9％),x2=6.357,P＜0.05;HBeAg阳性和阴性患者肝组织纤维化分期分布差异无统计学意义(x2=4.061,P＞0.05).多因素Logistic回归分析结果显示,年龄是肝脏病理炎症和纤维化轻重程度的独立危险因素(OR值分别为1.92和2.11,P值均＜0.05).结论 ALT轻度升高慢性乙型肝炎患者中,HBeAg状态与肝脏病理炎症及纤维化程度无关.年龄≥40岁的HBeAg阳性患者中、重度炎症比例明显升高;不同HBV DNA水平的HBeAg阳性与阴性患者肝脏炎症分级也有差异.
目的 分析ALT輕度升高(1～2倍正常值上限)的HBeAg暘性和陰性慢性乙型肝炎患者肝組織病理學特點,併探討年齡及HBV DNA水平對其的影響.方法 收集2009年10月至2011年3月,“十一五”國傢科技重大專項——慢性乙型肝炎中西醫結閤治療方案入組病例中符閤條件者,行B超引導下肝穿刺活組織檢查,併檢測HBsAg、HBeAg滴度及HBV DNA水平.比較HBeAg暘性和陰性患者炎癥分級和纖維化分期情況及年齡(≥40歲和＜40歲)、HBVDNA水平(≥105拷貝/ml和＜105拷貝/ml)對其的影響.兩樣本構成比的比較用x2檢驗,相關性分析用多因素logistic迴歸分析.結果 389例HBeAg暘性與126例HBeAg陰性患者的肝組織炎癥分級與纖維化分期分佈差異均無統計學意義(x2值分彆為4.326和3.464,P值均＞0.05).＜40歲組中,HBeAg暘性與陰性患者的炎癥分級及纖維化分期分佈差異無統計學意義(x2值分彆2.543和5.024,P值均＞0.05).≥40歲組中,HBeAg暘性患者中、重度炎癥(G3、G4)所佔百分比(32.9％)明顯高于HBeAg陰性者(16.4％),x2=8.777,P＜0.05;纖維化分期分佈差異無統計學意義(x2=0.977,P＞0.05).HBV DNA≥105拷貝/ml患者中,HBeAg暘性患者輕度炎癥(Gl)所佔百分比(17.5％)明顯高于HBeAg陰性患者(7.3％),x2=8.851,P＜0.05;HBeAg暘性和陰性患者肝組織纖維化分期分佈差異無統計學意義(x2=8.227,P＞0.05).HBVDNA＜105拷貝/ml的患者中,HBeAg陰性患者輕度炎癥(Gl)所佔百分比(29.6％)明顯高于HBeAg暘性患者(6.9％),x2=6.357,P＜0.05;HBeAg暘性和陰性患者肝組織纖維化分期分佈差異無統計學意義(x2=4.061,P＞0.05).多因素Logistic迴歸分析結果顯示,年齡是肝髒病理炎癥和纖維化輕重程度的獨立危險因素(OR值分彆為1.92和2.11,P值均＜0.05).結論 ALT輕度升高慢性乙型肝炎患者中,HBeAg狀態與肝髒病理炎癥及纖維化程度無關.年齡≥40歲的HBeAg暘性患者中、重度炎癥比例明顯升高;不同HBV DNA水平的HBeAg暘性與陰性患者肝髒炎癥分級也有差異.
목적 분석ALT경도승고(1～2배정상치상한)적HBeAg양성화음성만성을형간염환자간조직병이학특점,병탐토년령급HBV DNA수평대기적영향.방법 수집2009년10월지2011년3월,“십일오”국가과기중대전항——만성을형간염중서의결합치료방안입조병례중부합조건자,행B초인도하간천자활조직검사,병검측HBsAg、HBeAg적도급HBV DNA수평.비교HBeAg양성화음성환자염증분급화섬유화분기정황급년령(≥40세화＜40세)、HBVDNA수평(≥105고패/ml화＜105고패/ml)대기적영향.량양본구성비적비교용x2검험,상관성분석용다인소logistic회귀분석.결과 389례HBeAg양성여126례HBeAg음성환자적간조직염증분급여섬유화분기분포차이균무통계학의의(x2치분별위4.326화3.464,P치균＞0.05).＜40세조중,HBeAg양성여음성환자적염증분급급섬유화분기분포차이무통계학의의(x2치분별2.543화5.024,P치균＞0.05).≥40세조중,HBeAg양성환자중、중도염증(G3、G4)소점백분비(32.9％)명현고우HBeAg음성자(16.4％),x2=8.777,P＜0.05;섬유화분기분포차이무통계학의의(x2=0.977,P＞0.05).HBV DNA≥105고패/ml환자중,HBeAg양성환자경도염증(Gl)소점백분비(17.5％)명현고우HBeAg음성환자(7.3％),x2=8.851,P＜0.05;HBeAg양성화음성환자간조직섬유화분기분포차이무통계학의의(x2=8.227,P＞0.05).HBVDNA＜105고패/ml적환자중,HBeAg음성환자경도염증(Gl)소점백분비(29.6％)명현고우HBeAg양성환자(6.9％),x2=6.357,P＜0.05;HBeAg양성화음성환자간조직섬유화분기분포차이무통계학의의(x2=4.061,P＞0.05).다인소Logistic회귀분석결과현시,년령시간장병리염증화섬유화경중정도적독립위험인소(OR치분별위1.92화2.11,P치균＜0.05).결론 ALT경도승고만성을형간염환자중,HBeAg상태여간장병리염증급섬유화정도무관.년령≥40세적HBeAg양성환자중、중도염증비례명현승고;불동HBV DNA수평적HBeAg양성여음성환자간장염증분급야유차이.
Objective To alalyse the live pathology characteristics in mild ALT-elevated (1× ULN ≤ALT ≤ 2 × ULN ) HBeAg-positive and HBeAg-negative chronic hepatitis B (CHB) patients,and to explore the influence of the age and HBV DNA level to liver pathology in different HBeAg status patients.Methods All the patients who met the inclusion criteria form "eleventh five-year plan" National Science and Technology Major Project,the treatment program of integrative traditional and western medicine for CHB were enrolled in this study between October 2009 and March 2011.B type ultrasound-guided liver biopsy was carried out in all patients and hepatitis B surface antigen (HBsAg),HBeAg titer as well as HBV DNA level were detected at the same time.Hepatic tissue inflammation and fibrosis degree of patients according to HBeAg-positive and negative,age( ≥ 40 years and ＜40 years),HBV DNA level( ≥ 105copy/ml and ＜105 copy/ml)were compared respectively.Chi-square test was used to compare the constitute percentage between the two samples.Multivariate logistic regression analysis was also performed to evaluate the correlation between different factors.Results There were no significant difference in the grade of liver inlammation and the stage of liver fibrosis between 389 HBeAg positive and 126 HBeAg-negative patients(x2 =4.326 andx2 =3.464,respectively,P values were all＞ 0.05).In the group of patients with age＜40 years,the distribution of different liver inflammation and fibrosis had no significant difference between HBeAg-positive and negative patients (x2 =2.543 and x2 =5.024,respectively,P values were all＞ 0.05).In the group of patient with age ≥ 40 years,the percentage of moderate and severe inflammation (G3,G4) HBeAg-positive patients(32.9％) owned is much higher than that of HBeAg-negative patients(16A％),x2 =8.777,P＜ 0.05.But the stage of liver fibrosis in HBeAg-positive patients was not significantly different than that of HBeAg-negative ones (x2 =0.977,P＞0.5).In the group of patients with HBV DNA ≥ 105copy/ml,the percentage of mild inflammation in HBeAg-positive patients (17.5％) was much high than that of HBeAg-negative patients(7.3％),x2 =8.851,P＜0.05.Thestage of liver fibrosis between HBeAg-positive and negative patients was no significant difference(x2 =8.227,P＞ 0.05).In the patients with HBV DNA ＜105 copy/ml,The percentage of HBeAg-negative patients(29.6％)with mild inflammation(G1) was much higher than HBeAg-positve patients(6.9％),x2 =6.357,P＜ 0.05.Therewas no significant difference in the stage of liver fibrosis between HBeAg-positve and negative patients(x2 =4.061,P＞0.05).The results of multivariate logistic regression analysis showed that age was the independent risk factor for different degree of liver inflammation and fibrosis seriousness.Conclusion The status of HBeAg has no association with the grade of liver inflammation and the stage of liver fibrosis in CHB patients with mildly elevated ALT.The percentage of moderate and severe inflanmmation in the HBeAg-positve patients with age ≥ 40years was significantly elevated.The grade of liver inflammation has significant difference between HBeAg-positive and negative patients with different HBV DNA levels as well.
