中华实验和临床感染病杂志（电子版）
中華實驗和臨床感染病雜誌（電子版）
중화실험화림상감염병잡지（전자판）
CHINESE JOURNAL OF EXPERIMENTAL AND CLINICAL INFECTIOUS DISEASES(ELECTRONIC VERSION)
2014年
1期
17-21
,共5页
张娜%赵莹莹%欧蔚妮%王笑梅%段英%程丹颖%李贲%罗爽%邢卉春%王凤水%王鹏%王琦%成军
張娜%趙瑩瑩%歐蔚妮%王笑梅%段英%程丹穎%李賁%囉爽%邢卉春%王鳳水%王鵬%王琦%成軍
장나%조형형%구위니%왕소매%단영%정단영%리분%라상%형훼춘%왕봉수%왕붕%왕기%성군
肝炎,乙型,慢性%丙氨酸氨基转移酶%肝组织%病理变化
肝炎,乙型,慢性%丙氨痠氨基轉移酶%肝組織%病理變化
간염,을형,만성%병안산안기전이매%간조직%병리변화
Chronic hepatitis B (CHB)%Alanine aminotransferase (ALT)%Liver biopsy%Histologic analysis
目的：对ALT正常或轻度异常尤其年龄偏大，有HBV感染家族史的患者行肝组织活检，了解该部分患者肝组织学特征及其肝脏炎症及纤维化程度，以便实时地给患者进行抗病毒治疗提供理论依据。方法选择首都医科大学附属北京地坛医院2005至2010年住院行肝组织活检的慢性HBV感染者，入组者符合慢性乙型肝炎诊断标准，排除合并其他病毒感染及其他肝病、严重心肺疾病等。采集患者基本信息包括性别、年龄、乙型肝炎家族史、饮酒史及用药史。肝组织学穿刺术前需检查血常规、凝血酶原活动度、肝功能、HBV DNA、腹部彩色多普勒超声；常规肝组织活检，结果用肝脏炎症分级（G0～G4）及纤维化分期（S0～S4）表示。以肝组织炎症分级分成轻度炎症（G0～G1）和明显炎症（G2～G4），以肝组织维化分期分成轻度纤维化（S0～S1）和明显纤维化（S2～S4）。结果符合入组条件的患者共229例，其中男性160例，女性69例；ALT持续正常者（PNAL）104例，ALT轻度异常组125例。全部入组患者肝病理学分析显示：肝脏炎症分级≥G2期者占45.42%；肝脏纤维化分期≥S2期者占35.38%。随ALT水平的升高，患者的肝脏炎症分级与纤维化分期增高，148例未接受抗病毒治疗的慢性HBV感染者在2～5年随访中，29.7%（44/148）患者ALT水平波动在40～50 U/L，70.3%（104/148）的患者ALT水平、HBV DNA水平均无显著波动（P＞0.05）；3例（2.1%）患者发生HBeAg血清学转换，分别发生在27岁、31岁和19岁时。结论 ALT正常或轻度异常者中有相当一部分患者存在明显的肝脏炎症及纤维化；即使肝组织活检炎症、纤维化较轻，也有相当一部分患者在2～5年内会出现肝病进展，需引起注意。
目的：對ALT正常或輕度異常尤其年齡偏大，有HBV感染傢族史的患者行肝組織活檢，瞭解該部分患者肝組織學特徵及其肝髒炎癥及纖維化程度，以便實時地給患者進行抗病毒治療提供理論依據。方法選擇首都醫科大學附屬北京地罈醫院2005至2010年住院行肝組織活檢的慢性HBV感染者，入組者符閤慢性乙型肝炎診斷標準，排除閤併其他病毒感染及其他肝病、嚴重心肺疾病等。採集患者基本信息包括性彆、年齡、乙型肝炎傢族史、飲酒史及用藥史。肝組織學穿刺術前需檢查血常規、凝血酶原活動度、肝功能、HBV DNA、腹部綵色多普勒超聲；常規肝組織活檢，結果用肝髒炎癥分級（G0～G4）及纖維化分期（S0～S4）錶示。以肝組織炎癥分級分成輕度炎癥（G0～G1）和明顯炎癥（G2～G4），以肝組織維化分期分成輕度纖維化（S0～S1）和明顯纖維化（S2～S4）。結果符閤入組條件的患者共229例，其中男性160例，女性69例；ALT持續正常者（PNAL）104例，ALT輕度異常組125例。全部入組患者肝病理學分析顯示：肝髒炎癥分級≥G2期者佔45.42%；肝髒纖維化分期≥S2期者佔35.38%。隨ALT水平的升高，患者的肝髒炎癥分級與纖維化分期增高，148例未接受抗病毒治療的慢性HBV感染者在2～5年隨訪中，29.7%（44/148）患者ALT水平波動在40～50 U/L，70.3%（104/148）的患者ALT水平、HBV DNA水平均無顯著波動（P＞0.05）；3例（2.1%）患者髮生HBeAg血清學轉換，分彆髮生在27歲、31歲和19歲時。結論 ALT正常或輕度異常者中有相噹一部分患者存在明顯的肝髒炎癥及纖維化；即使肝組織活檢炎癥、纖維化較輕，也有相噹一部分患者在2～5年內會齣現肝病進展，需引起註意。
목적：대ALT정상혹경도이상우기년령편대，유HBV감염가족사적환자행간조직활검，료해해부분환자간조직학특정급기간장염증급섬유화정도，이편실시지급환자진행항병독치료제공이론의거。방법선택수도의과대학부속북경지단의원2005지2010년주원행간조직활검적만성HBV감염자，입조자부합만성을형간염진단표준，배제합병기타병독감염급기타간병、엄중심폐질병등。채집환자기본신식포괄성별、년령、을형간염가족사、음주사급용약사。간조직학천자술전수검사혈상규、응혈매원활동도、간공능、HBV DNA、복부채색다보륵초성；상규간조직활검，결과용간장염증분급（G0～G4）급섬유화분기（S0～S4）표시。이간조직염증분급분성경도염증（G0～G1）화명현염증（G2～G4），이간조직유화분기분성경도섬유화（S0～S1）화명현섬유화（S2～S4）。결과부합입조조건적환자공229례，기중남성160례，녀성69례；ALT지속정상자（PNAL）104례，ALT경도이상조125례。전부입조환자간병이학분석현시：간장염증분급≥G2기자점45.42%；간장섬유화분기≥S2기자점35.38%。수ALT수평적승고，환자적간장염증분급여섬유화분기증고，148례미접수항병독치료적만성HBV감염자재2～5년수방중，29.7%（44/148）환자ALT수평파동재40～50 U/L，70.3%（104/148）적환자ALT수평、HBV DNA수평균무현저파동（P＞0.05）；3례（2.1%）환자발생HBeAg혈청학전환，분별발생재27세、31세화19세시。결론 ALT정상혹경도이상자중유상당일부분환자존재명현적간장염증급섬유화；즉사간조직활검염증、섬유화교경，야유상당일부분환자재2～5년내회출현간병진전，수인기주의。
Objective To investigate the liver histological features and the relative influencing factors of the chronic hepatitis B (CHB) patients with persistently normal or slightly elevated alanine aminotransferase (ALT) level, all of the patients recruited accepted liver biopsy with a normal or mild evaluation of ALT, especially those who were older or had a family history of hepatocelluar carcinoma. And to investigate whether the biopsy feature could supply theoretical foundation for antivirus therapy. Methods Total of 229 CHB patients from 2005 to 2010, who accepted liver biopsy in Beijing Ditan Hospital, Capital Medical University were enrolled. The subjects met the diagnostic criteria (chronic hepatitis guideline) and exclusion criteria. All study participants were only infected with HBV, excluding virual hepatitis, severe cardiovascular diseases, etc, whose ALT level less was than 2 × ULN. The related inlfuencing factors were analyzed, retrospectively. Clinical data, such as gender, age, family history, history of alcohol and drug abuse history of the inpatients were collected, respectively. Results There were 160 male and 69 female patiens. The percentage of whom with persistent normal (PNAL) ALT level was 45.41% (104/229), and mild ALT evaluating was 54.59%(125/229). Liver biopsy histologic analysis showed the percentage of liver inlfammation and ifbrosis≥G2 grade,≥S2 stage were 45.42%and 35.38%, respectively;accompanied by the rising ALT, the degree of the liver inlfammation and ifbrosis were getting higher. After a 5-year follow-up, there were 148 patients with HBV infection, who never accepted antivirus therapy, had a mild rise of ALT level (40-50 U/L) with 29.7%(44/149), while 70.3%(104/148) patients had no change of ALT or HBV load (P>0.05), and there were 3 (2.1%) patients with HBeAg seroconversion, happened at the age of 27, 31 and 19. Conclusions Some of the patients with normal or slightly elevated ALT may have severe liver inflammation and fibrosis. Although whose liver inflammation and fibrosis was slight abnormal, many of them would had progress in liver diseases, what should be paid attention to.
