高病毒载量且ALT水平正常或轻度升高CHB患者临床和组织病理学特征

肝脏 ›› 2021, Vol. 26 ›› Issue (11): 1228-1230.

高病毒载量且ALT水平正常或轻度升高CHB患者临床和组织病理学特征

徐芳, 张海泉, 赵佳强

519000 广东珠海市人民医院(暨南大学附属珠海医院)检验科(徐芳,赵佳强),麻醉科(张海泉)

收稿日期:2020-11-30 出版日期:2021-11-30 发布日期:2021-12-24
通讯作者: 徐芳,Email:m9o8k3@163.com
基金资助:
珠海市科技计划项目(20171009E030093)

Clinical and histopathological features of CHB patients with high viral load but normal or slightly elevated ALT levels

XU Fang¹, ZHANG Hai-quan², ZHAO Jia-qiang¹

1. Department of Laboratory, Zhuhai People's Hospital, Guangdong 519000, China;
2. Department of Anesthesiology, Zhuhai People's Hospital, Guangdong 519000, China

Received:2020-11-30 Online:2021-11-30 Published:2021-12-24
Contact: XU Fang,Email:m9o8k3@163.com

摘要/Abstract

摘要： 目的分析高HBV DNA病毒载量、ALT水平正常或轻度升高的CHB患者临床和组织病理学特征。方法纳入2016年1月至2020年9月珠海市人民医院诊治的CHB患者378例,男性206例,女性172例,年龄(34.8±6.4)岁。采用Scheuer评分系统、组织学活动指数评价患者肝纤维化分期(F0～F4)及肝组织炎症活动度分级(G0～G4)。计量资料采用t检验;计数资料采用卡方检验。结果 CHB患者中＜F2期135例,≥F2期243例,＜F2期患者年龄、HBV DNA、ALT、APRI及γ-谷氨酰转肽酶/血小板技术模型(GPR)分别为(32.8±9.2)岁、(8.4±1.0)log₁₀拷贝/mL、(45.8±5.5)U/L、(0.40±0.22)及(0.12±0.07),与≥F2期[(35.6±5.3)岁、(7.6±1.3)log₁₀拷贝/mL、(56.8±7.0)U/L、(0.49±0.20)及(0.17±0.08)]比,差异具有统计学意义(P<0.05)。CHB患者中＜G2期142例,≥G2期236例,＜G2期患者年龄、HBV DNA、ALT、AST、FIB-4、APRI及GPR分别为(33.6±8.4)岁、(8.4±1.1)log10 copies/mL、(46.1±5.4)U/L、(32.5±8.2)U/L、(0.19±0.11)、(0.40±0.23)及(0.12±0.08),与≥F2期[(35.2±7.5)岁、(7.4±1.4)log₁₀拷贝/mL、(56.0±6.8)U/L、(38.7±5.5)U/L、(0.24±0.11)、(0.55±0.22)及(0.17±0.10)]比,差异具有统计学意义(P<0.05)。结论对于年龄较大、病毒载量持续上升或FIB-4、APRI、GPR异常的ALT正常或轻度升高CHB患者需要加强随访,必要时进行肝穿刺活检。

关键词: 慢性乙型肝炎, 丙氨酸氨基转移酶, 肝纤维化, 肝组织炎症活动度

Abstract: Objective To analyze the clinical and histopathological features of chronic hepatitis B (CHB) patients with high HBV DNA viral load but normal or slightly elevated alanine aminotransferase (ALT) levels. Methods Three hundred and seventy-eight CHB patients aged (34.8±6.4) years including 206 males and 172 females were collected from January 2016 to September 2020. Scheuer scoring system and histological activity index were used to evaluate the stage of liver fibrosis (F0~F4) and the grade of inflammatory activity of liver tissue (G0~G4). Measurement data are analyzed by t-test; counting data were analyzed by Chi-square test. Results The age, HBV DNA load, ALT level, Aspartate aminotransferase-to-Platelet Ratio Index (APRI), and gamma-glutamyl transpeptidase to platelet ratio (GPR) for patients <F2 stage were (32.8±9.2) years, (8.4±1.0) log₁₀ copies/mL, (45.8±5.5)U/L, (0.40±0.22) and (0.12±0.07), respectively, compared with those of (35.6±5.3)years, (7.6±1.3)log₁₀ copies/mL, (56.8±7.0)U/L, (0.49±0.20) and (0.17±0.08) for patients ≥F2 stage, respectively, the difference was statistically significant (P<0.05). The age, HBV DNA, ALT, AST, FIB-4, APRI and GPR for patients<G2 stage were (33.6±8.4)years, (8.4±1.1)log₁₀ copies/mL, (46.1±5.4)U/L, (32.5±8.2)U/L, (0.19±0.11), (0.40±0.23), (0.12±0.08), respectively, compared with those of (35.2±7.5) years, (7.4±1.4)log₁₀ copies/mL, (56.0±6.8)U/L, (38.7±5.5)U/L, (0.24±0.11), (0.55±0.22), (0.17±0.10) for patients ≥F2 stage, respectively, the difference was statistically significant (P<0.05). Conclusion It is necessary to strengthen the follow-up if the CHB patients are in older age, have normal or slightly elevated ALT, but have continuously increased viral load or abnormal FIB-4, APRI and GPR. Liver biopsy need to be performed whenever necessary.

Key words: Chronic hepatitis B, Alanine aminotransferase, Liver fibrosis, Inflammatory activity of liver tissue

徐芳, 张海泉, 赵佳强. 高病毒载量且ALT水平正常或轻度升高CHB患者临床和组织病理学特征[J]. 肝脏, 2021, 26(11): 1228-1230.

XU Fang, ZHANG Hai-quan, ZHAO Jia-qiang. Clinical and histopathological features of CHB patients with high viral load but normal or slightly elevated ALT levels[J]. Chinese Hepatolgy, 2021, 26(11): 1228-1230.

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