CAJ | 학술논문

目的了解ALT正常的慢性HBV感染者的肝脏病理学改变及其影响因素.方法观察632例ALT正常的慢性HBV感染者,采用超声定位穿刺取肝组织,行HE染色、纤维Masson染色,HBsAg和HBcAg免疫组织化学染色,观察Knodell坏死炎症评分和Ishak纤维化评分,并分析它们与年龄、ALT水平、血清HBV DNA载量、HBsAg和HBcAg肝组织表达的关系.两均数比较采用t检验,多均数比较采用单因素方差分析及q检验,计数资料采用x2检验.结果 632例ALT正常的HBV感染者中,中度炎症坏死167例,占26.4%,重度炎症坏死26例,占4.1%,中度纤维化217例,占34.3%,重度纤维化(肝硬化)52例,占8.2%.Knodell坏死炎症评分和Ishak纤维化评分在高ALT层次组比低ALT层次组高,在女性高ALT层次组比男性高ALT层次组高,在年龄＞40岁组比年龄≤20岁组高(q=19.63,P＜0.05).肝组织损伤程度在HBV DNA载量≤5×105拷贝/L组明显轻于HBV DNA 5×105～1×107拷贝/L、1×107～1×109拷贝/L和＞1×109拷贝/L组(Knodell评分,q=3.87、2.87、6.34;Ishak评分,q=2.64、2.64、5.54;均P＜0.05),在不同HBV DNA载量复制组之间差异无统计学意义(F=1.35,P＞0.05).HBsAg(F=1.65、0.73,均P＞0.05)和HBcAg(F=0.17、1.29,均P＞0.05)肝组织表达与Knodell坏死炎症评分和Ishak纤维化评分差异均无统计学意义.结论可检测到HBV DNA的ALT持续正常的慢性HBV感染患者应考虑进行肝组织活检,特别是年龄＞40岁且ALT在(0.75～1.00)×正常值上限者.
목적 료해ALT정상적만성HBV감염자적간장병이학개변급기영향인소.방법 관찰632례ALT정상적만성HBV감염자,채용초성정위천자취간조직,행HE염색、섬유Masson염색,HBsAg화HBcAg면역조직화학염색,관찰Knodell배사염증평분화Ishak섬유화평분,병분석타문여년령、ALT수평、혈청HBV DNA재량、HBsAg화HBcAg간조직표체적관계.량균수비교채용t검험,다균수비교채용단인소방차분석급q검험,계수자료채용x2검험.결과 632례ALT정상적HBV감염자중,중도염증배사167례,점26.4%,중도염증배사26례,점4.1%,중도섬유화217례,점34.3%,중도섬유화(간경화)52례,점8.2%.Knodell배사염증평분화Ishak섬유화평분재고ALT층차조비저ALT층차조고,재녀성고ALT층차조비남성고ALT층차조고,재년령＞40세조비년령≤20세조고(q=19.63,P＜0.05).간조직손상정도재HBV DNA재량≤5×105고패/L조명현경우HBV DNA 5×105～1×107고패/L、1×107～1×109고패/L화＞1×109고패/L조(Knodell평분,q=3.87、2.87、6.34;Ishak평분,q=2.64、2.64、5.54;균P＜0.05),재불동HBV DNA재량복제조지간차이무통계학의의(F=1.35,P＞0.05).HBsAg(F=1.65、0.73,균P＞0.05)화HBcAg(F=0.17、1.29,균P＞0.05)간조직표체여Knodell배사염증평분화Ishak섬유화평분차이균무통계학의의.결론 가검측도HBV DNA적ALT지속정상적만성HBV감염환자응고필진행간조직활검,특별시년령＞40세차ALT재(0.75～1.00)×정상치상한자.
Objective To study the liver histological changes in chronic hepaitits B (CHB) patients with normal serum alanine aminotransferase (ALT) levels and the related factors. Methods Six hundred and thirty-two CHB patients with normal ALT levels had undergone ultrasound guided percutaneous liver biopsies. All specimen were examined by HE staining, collagen fiber Masson staining and immunohistochemical staining for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg). The Knodell inflammation score and Ishak fibrosis score were both calculated and the relationship with age, serum levels of ALT and hepatitis B virus (HBV) DNA, hepatic expressions of HBsAg and HBcAg were analyzed. The means between two groups were compared by t test and those among groups were compared by one-factor analysis of variance and q test. Enumeration data were analyzed by x2 test. Results Among 632 CHB patients with normal ALT levels, 167 (26.4%) showed moderate necrotic inflammation in liver tissues and 26 (4.1%) showed severe necrotic inflammation; 217 (34. 3 % ) showed moderate fibrosis and 52 (8. 2 % ) showed severe fibrosis (cirrhosis). The Knodell inflammation score and Ishak fibrosis score in high ALT group were higher than low ALT group, those in female high ALT group were higher than male high ALT group and those in patients ＞ 40 years old were higher than ≤20 years old (q= 19.63, P＜0. 05). The liver injuries in patients with active HBV replication were more severe than those with undetectable HBV DNA levels (Knodell score, q=3.87, 2.87, 6.34; Ishak score, q=2.64,2. 64,5.54, all P＜0. 05),while there was no significant difference between patients with high levels and low levels of HBV DNA (F= 1.35, P＞0. 05). There was no significant difference between expressions of HBsAg (F= 1.65,0. 73,respectively; both P＞0. 05) and HBcAg in liver tissues and Knodell inflammation score and Ishak fibrosis score (F=0. 17, 1.29, respectively; both P＞0. 05). Conclusions Liver biopsies should be considered in CHB patients with normal ALT levels and detectable HBV DNA levels, especially those ＞ 40 years old and with ALT of (0.75-1.00) × upper limits of normal (ULN).