关键词: 乙型肝炎病毒携带者, 慢性乙型肝炎, 丙氨酸氨基转移酶, 肝组织Knodell’, s计分, 抗病毒治疗

Abstract: Objective To explore the liver pathologic changes in chronic Hepatitis B （CHB） patients with mildly elevated serum alanine aminotransferase levels after two-year followed-up. Methods 167 CHB patients with serum ALT<2 upper limit of normal（ULN） who underwent liver biopsy were included in this study. The patients were followed-up for two years,and the liver biopsies were performed at presentation and at the end of two year observation. Serum HBsAg,HBeAg,HBV DNA and ALT were conventionally detected,and Logistic regression was conducted to find the influencing factors for the liver tissue pathology changes. Results 33（37.5%） had,and 55（62.5%） had not aggravated liver tissue injuries out of 88 hepatitis B virus carriers at the end of two year follow-up,the ages of those with aggravated liver injuries at presentation were（39.7±7.6） yr,older than in without liver injuries[（30.2±9.7）yr,P<0.05],and the serum HBeAg positive rate（51.5%） and the serum level of HBsAg [（3.22±0.51） lgIU/ml] were much lower than in those without liver injuries [（81.8%） and （3.50±0.53） lgIU/ml,respectively,P<0.05];The age was an important factor affecting liver pathological progress by Logistic regression analysis（OR=1.118,P=0.002）. 62（78.5%） had improved hepatic histological activity of Knodell 's score in 79 patients with CHB after antiviral therapy at the end of two year follow-up. Conclusion The risk of liver tissue pathological progression increased as the hepatitis B virus carriers get older than 40 years in those with serum HBeAg negative and mildly elevated serum ALT levels,and we recommends them having liver biopsy in time,and have antiviral therapy as necessary.

Key words: Hepatitis B virus carriers, Hepatitis B, Alanine aminotransferase, Knodell’s score, Antiviral therapy