CAJ | 학술논문

目的：探索在ALT＜2倍正常值上限（2×ULN）的慢性HBV感染人群中，一般临床指标对肝脏病理结果的预测作用。方法收集2009年1月至2013年6月新乡医学院第一附属医院收治的122例ALT＜2×ULN的慢性HBV感染者，在超声引导下行肝穿刺活组织检查术，判断肝组织炎症活动度及纤维化程度，同期化验肝功能、乙型肝炎血清标志物、HBV DNA等指标，应用Logis-tic回归分析法探索该类患者的一般临床指标对其肝脏病理结果的预测作用。结果122名患者中有明显炎症或纤维化（G≥2或S≥2）者共94例（77．0％），早期肝硬化者5例（4．1％）。G＜2组与G≥2组相比，除HBV DNA外，其余各指标间差异均无统计学意义；S＜2组与S≥2组相比，年龄、HBeAg、HBV DNA、AST、血小板差异均有统计学意义；Logistic回归分析提示，年龄、HBeAg和AST是肝脏明显纤维化（S≥2）的独立预测因子。结论对血清ALT＜2×ULN的慢性HBV感染者，年龄＞40岁、HBeAg阴性、AST＞40 U/L者应积极进行肝穿刺活组织检查术，必要时尽早抗病毒治疗。
목적：탐색재ALT＜2배정상치상한（2×ULN）적만성HBV감염인군중，일반림상지표대간장병리결과적예측작용。방법수집2009년1월지2013년6월신향의학원제일부속의원수치적122례ALT＜2×ULN적만성HBV감염자，재초성인도하행간천자활조직검사술，판단간조직염증활동도급섬유화정도，동기화험간공능、을형간염혈청표지물、HBV DNA등지표，응용Logis-tic회귀분석법탐색해류환자적일반림상지표대기간장병리결과적예측작용。결과122명환자중유명현염증혹섬유화（G≥2혹S≥2）자공94례（77．0％），조기간경화자5례（4．1％）。G＜2조여G≥2조상비，제HBV DNA외，기여각지표간차이균무통계학의의；S＜2조여S≥2조상비，년령、HBeAg、HBV DNA、AST、혈소판차이균유통계학의의；Logistic회귀분석제시，년령、HBeAg화AST시간장명현섬유화（S≥2）적독립예측인자。결론대혈청ALT＜2×ULN적만성HBV감염자，년령＞40세、HBeAg음성、AST＞40 U/L자응적겁진행간천자활조직검사술，필요시진조항병독치료。
Objective To investigate the role of various clinical parameters in predicting liver injury stage in patients with chronic hepatitis B virus (HBV)infection who had alanine aminotransferase (ALT)levels lower than 2 times the upper limit of normal (ULN).Methods Ultrasound-guided liver biopsy was performed in chronic HBV infection patients with ALT levels lower than 2 ×ULN.The activity of in-flammation and degree of fibrosis in liver tissues were assessed.Meanwhile,liver function,serum HBV markers,and HBV DNA were meas-ured.The role of these clinical parameters in predicting liver injury stage was evaluated by logistic regression analysis.Results Among 122 patients,94 (77.0%)had significant inflammation or fibrosis (G≥2 or S≥2),and 5 (4.1%)had early cirrhosis.There was significant difference in HBV DNA between G≥2 group and G <2 group,but other parameters showed no significant differences between the two groups.There were significant differences in age,HBeAg,HBV DNA,AST,and platelet count between S≥2 group and S<2 group.The logistic regression analysis showed that age,HBeAg,and AST were independent predictors of significant liver fibrosis (S≥2).Conclusion Liver biopsy is necessary for chronic HBV infection patients with serum ALT levels of <2 ×ULN,aged over 40 years,negative for HBeAg, or with serum AST levels of >40 U/L.