CAJ | 학술논문

目的探讨CHB患者肝脏炎症活动度(G)和纤维化程度(S)的影响因素.方法对971例CHB患者进行肝组织病理学检查,同时收集患者的血生物化学、血常规、HBV DNA、HBV血清学标志物等数据.计数资料比较采用卡方检验,3组间计量资料的比较采用单因素方差分析,两组间计量资料的比较采用Student-t检验,相关性分析采用Spearman相关分析和多元回归分析.结果 971例患者分成3组.1年内ALT 3次持续正常列为A组,首次发现ALT升高者列为B组,半年内ALT升高两次以上者列为C组.A组332例,B组341例,C组298例.3组HBV感染者男性人数分别占47.9％、74.2％、73.8％,差异有统计学意义(x2=64.778,P＜0.01).A组中HBeAg阳性者161例(48.5％),B组234例(69.0％),C组176例(59.1％),差异有统计学意义(x2=28.325,P＜0.01).3组G≥2者分别占36.4％、56.9％、51.3％(x2=29.868,P＜0.01),S≥2者分别为25.3％、35.5％、35.9％(x2=10.807,P=0.005).A组G≥2和(或)S≥2的有137例(41.3％),B组有208例(61.0％),C组有164例(55.0％),差异有统计学意义(x2 =22.235,P＜0.01).将A组分为ALT＜30 U/L组(229例)和ALT≥30 U/L组(103例),两组间男性、HBeAg阳性、G≥2和(或)S≥2患者比例的差异均有统计学意义(均P＜0.05).Spearman相关分析和Logistic回归分析显示,年龄≥35岁、ALT≥30 U/L、AST≥25 U/L、HBeAg阳性、血小板计数与显著病理学改变相关(均P＜0.05),年龄(OR=2.012,95％CI为1.196～3.383)、HBeAg(OR=2.188,95％CI为1.339～3.584)和AST(OR=2.312,95％CI为1.390～3.846)为显著病理学改变的独立预测因素.结论对ALT首次发现升高者,其显著肝脏组织病理学改变比例与反复升高的患者相似,建议早期抗病毒治疗.对ALT持续正常的感染者,年龄≥35岁、HBeAg阳性或AST≥25 U/L为显著病理学改变的独立预测因素,对符合上述条件的患者更应引起注意,进行早期的抗病毒治疗.
목적 탐토CHB환자간장염증활동도(G)화섬유화정도(S)적영향인소.방법 대971례CHB환자진행간조직병이학검사,동시수집환자적혈생물화학、혈상규、HBV DNA、HBV혈청학표지물등수거.계수자료비교채용잡방검험,3조간계량자료적비교채용단인소방차분석,량조간계량자료적비교채용Student-t검험,상관성분석채용Spearman상관분석화다원회귀분석.결과 971례환자분성3조.1년내ALT 3차지속정상렬위A조,수차발현ALT승고자렬위B조,반년내ALT승고량차이상자렬위C조.A조332례,B조341례,C조298례.3조HBV감염자남성인수분별점47.9％、74.2％、73.8％,차이유통계학의의(x2=64.778,P＜0.01).A조중HBeAg양성자161례(48.5％),B조234례(69.0％),C조176례(59.1％),차이유통계학의의(x2=28.325,P＜0.01).3조G≥2자분별점36.4％、56.9％、51.3％(x2=29.868,P＜0.01),S≥2자분별위25.3％、35.5％、35.9％(x2=10.807,P=0.005).A조G≥2화(혹)S≥2적유137례(41.3％),B조유208례(61.0％),C조유164례(55.0％),차이유통계학의의(x2 =22.235,P＜0.01).장A조분위ALT＜30 U/L조(229례)화ALT≥30 U/L조(103례),량조간남성、HBeAg양성、G≥2화(혹)S≥2환자비례적차이균유통계학의의(균P＜0.05).Spearman상관분석화Logistic회귀분석현시,년령≥35세、ALT≥30 U/L、AST≥25 U/L、HBeAg양성、혈소판계수여현저병이학개변상관(균P＜0.05),년령(OR=2.012,95％CI위1.196～3.383)、HBeAg(OR=2.188,95％CI위1.339～3.584)화AST(OR=2.312,95％CI위1.390～3.846)위현저병이학개변적독립예측인소.결론 대ALT수차발현승고자,기현저간장조직병이학개변비례여반복승고적환자상사,건의조기항병독치료.대ALT지속정상적감염자,년령≥35세、HBeAg양성혹AST≥25 U/L위현저병이학개변적독립예측인소,대부합상술조건적환자경응인기주의,진행조기적항병독치료.
Objective To analyze the influence factors of liver inflammation activity and fibrosis of patients with chronic hepatitis B (CHB) infection.Methods A total of 971 patients with chronic hapatitis B virus (HBV) infection,who underwent liver biopsy and routine laboratory testing,such as biochemical tests,blood routine examination,HBV DNA and serum hepatitis markers,were recruited.Categorical data were analyzed by Chi-square test.Quantitative data among three groups were compared by one-way analysis of variance.Quantitative data between two groups were compared by Student-t test,Spearman correlation analysis and multiple regression analysis.Results Nine hundred and seventy-one patients were divided into three groups including group A (more than three continuous normal alanine aminotransferase [ALT] within a year,n=332),group B (first elevated ALT,n=341) and group C (more than two or more elevated ALT within six months,n=298).The male patients in three groups were 47.9 ％,74.2 ％ and 73.8％,respectively,with statistical significance (x2 =64.778,P＜0.01).Hepatitis B e antigen (HBeAg)-positive patients in groups A,B and C were 161 (48.5％),234(69.0％) and 176(59.1％),respectively.The difference was statistically significant in three groups (x2 =28.325,P＜0.01).The proportions of patients with G≥2 in three groups were 36.4％,56.9％ and 51.3％,respectively (x2 =29.868,P＜0.01) ; and those of S≥2 were 25.3 ％,35.5 ％ and 35.9 ％,respectively (x2 =10.807,P=0.005).The proportions of patients with G≥2 and (or) S≥2 in three groups were 137(41.3％),208 (61.0％) and 164(55.0％),respectively.The differences were significant among three groups (x2=22.235,P＜0.01).Group A was divided into subgroup A1 (ALT＜30 U/L) with 229 cases and subgroup A2 (ALT≥30 U/L) with 103 cases.Differences of proportions of male,patients with HBeAg positivity and G≥2 and (or) S≥2 were statistically significant between sub groups A1 and A2 (all P＜0.05).The Spearman correlation analysis and Logistic regression analysis of group A showed that age older than 35 years,ALT≥30 U/L,aspartate aminotransferase (AST)≥25 U/L,HBeAg-positive and platelet counts were associated with significant pathological changes (all P＜0.05).Age (OR=2.012,95％CI:1.196-3.383),HBeAg-positive (OR=2.188,95％CI:1.339-3.584) and AST (OR=2.312,95％CI:1.390-3.846) were independent predictors for significant liver pathological changes.Conclusions The proportion of significant liver pathological changes in the patients with first elevated ALT is similar with that in patients with repeatedly ALT elevated.Thus,early antiviral treatment is recommended in those patients with first elevated ALT.Age≥35 years,HBeAg-positive and AST≥25 U/L are independent predictors for significant liver pathological changes of chronic HBV infected patients with ALT persistently normal.Therefore,for patients who meet the above conditions,early antiviral treatment should be initiated.