CAJ | 학술논문

目的观察在低丙氨酸氨基转移酶（ALT）水平（<2×ULN）的慢性HBV感染者中，不同ALT水平感染者临床生化指标和肝脏组织病理学分级的差异。方法根据ALT水平不同，将253例ALT小于2倍ULN患者分为三组，A 组为男性 ALT≤30U/L 和女性 ALT≤19U/L （n=74），B 组为男性30U/L<ALT≤60U/L 和女性19U/L<ALT≤38U/L（n=119），和C组为男性60U/L<ALT≤80U/L和女性38U/L<ALT≤80U/L（n=60）。观察各组人群血生化指标和肝脏炎症分级（G）和纤维化分期（S）的差异。结果本组A组、B组和C组患者HBeAg阳性率分别为39.2%、47.1%和71.7%（x2=15.1，P<0.01）；三组患者年龄分别为39.5±11.9岁、34.5±11.4岁和31.6±11.6岁（F=8.1，P=000）；A组血清AST、GGT和AST/血小板比值（APRI）分别为22.9±6.6u/L、31.6±22.9u/L和0.2±0.1，B组分别为36.5±26.7u/L、39.9±30.8u/L和0.3±0.2，C组分别为44.3±11.6u/L、47.3±49.3u/L和0.4±0.3，三组相差显著（P<0.05）；A组肝组织G2为16.2%，明显低于B组（35.3%）和C组（30.0%，P<0.05）；3组肝组织肝纤维化程度无显著性相差（P>0.05）。结论在ALT＜2倍ULN的HBV感染者中，不同ALT水平者血生化指标和肝组织炎症程度存在差异，需要区别处理。
목적관찰재저병안산안기전이매（ALT）수평（<2×ULN）적만성HBV감염자중，불동ALT수평감염자림상생화지표화간장조직병이학분급적차이。방법근거ALT수평불동，장253례ALT소우2배ULN환자분위삼조，A 조위남성 ALT≤30U/L 화녀성 ALT≤19U/L （n=74），B 조위남성30U/L<ALT≤60U/L 화녀성19U/L<ALT≤38U/L（n=119），화C조위남성60U/L<ALT≤80U/L화녀성38U/L<ALT≤80U/L（n=60）。관찰각조인군혈생화지표화간장염증분급（G）화섬유화분기（S）적차이。결과본조A조、B조화C조환자HBeAg양성솔분별위39.2%、47.1%화71.7%（x2=15.1，P<0.01）；삼조환자년령분별위39.5±11.9세、34.5±11.4세화31.6±11.6세（F=8.1，P=000）；A조혈청AST、GGT화AST/혈소판비치（APRI）분별위22.9±6.6u/L、31.6±22.9u/L화0.2±0.1，B조분별위36.5±26.7u/L、39.9±30.8u/L화0.3±0.2，C조분별위44.3±11.6u/L、47.3±49.3u/L화0.4±0.3，삼조상차현저（P<0.05）；A조간조직G2위16.2%，명현저우B조（35.3%）화C조（30.0%，P<0.05）；3조간조직간섬유화정도무현저성상차（P>0.05）。결론재ALT＜2배ULN적HBV감염자중，불동ALT수평자혈생화지표화간조직염증정도존재차이，수요구별처리。
Objective To evaluate the liver histopathological and biochemical features in 253 hepatitis B virus infected patients with low serum aminotransferase levels. Methods Two hundred and fifty-three HBV-in-fected patients with serum ALT less than 2íULN were divided into three groups according to ALT levels: i.e.,in group A with serum ALT≤30U/L for male and ALT≤19U/L for female,in group B with 30U/L<ALT≤60U/L for male and 19U/L<ALT≤38U/L for female,and in group C with 60U/L<ALT≤80U/L for male and 38U/L<ALT≤80U/L for female. Blood parameters and the grades of liver inflammation and stages of liver fibrosis were deter-mined. Results The serum HBeAg positive rates in group A,B and C were 39.2%,47.1% and 71.7%,respec-tively(x2=15.1,P<0.01);The patients’age were 39.5±11.9,34.5±11.4 and 31.6±11.6 year-old,respectively(F=8.1,P=000);The serum AST,GGT and the ratio of AST/ platelet (APRI)in group A were 22.9±6.6u/L,31.6±22.9u/L and 0.2±0.1,in group B were 36.5±26.7u/L,39.9±30.8u/L and 0.3±0.2,and in group C were 44.3±11.6u/L,47.3±49.3u/L and 0.4±0.3 (P<0.05);The hepatic G2 of inflammation in group A was 16.2%,much lower than in group B(35.3%)and in group C(30.0%,P<0.05),while there was no significantly different as respect to the liver fibrosis in the three gruops(P>0.05). Conclusion In hepatitis B infected patients with low serum ALT level,the liver in-flammation grades are dramatically different and may require different strategies of managements.