30岁以下血清ALT正常的成人慢性HBV感染者肝组织学变化研究

doi:10.3969/j.issn.1672-5069.2024.03.006

摘要/Abstract

摘要： 目的探讨30岁以下血清ALT正常的成人慢性HBV感染者肝组织学变化。方法 2013年～2023年河南科技大学第三附属医院诊治的血清ALT水平正常的年龄在30岁以下的成人慢性HBV感染者108例,均行肝穿刺活检。将肝组织炎症活动度分级≥G2和/或纤维化分期≥S2诊断为慢性乙型肝炎(CHB),达不到诊断标准的归为病毒携带者。应用二元Logistic回归分析影响肝组织显著病变的预测因素,应用受试者工作曲线(ROC)下面积(AUC)分析相关指标诊断显著肝组织学病变的效能。结果在108例HBV感染者中,发现G1S1 73例,即病毒携带者,发现G2/S2 30例和G3/S3 5例,即诊断CHB 35例;CHB患者有乙型肝炎家族史占比为65.7％,显著高于病毒携带者的13.7％(P＜0.05),CHB患者血清ALT水平和HBV DNA载量分别为(30.3±6.7)U/L和4.4(3.7,5.8)lgIU/ml,均显著高于病毒携带者【分别为(20.2±8.8)U/L和3.5(2.9,5.4) lgIU/ml,P＜0.05】;多因素分析显示血清ALT水平和HBV DNA载量是预测肝组织学显著病变的独立预测因素(P＜0.05);以血清ALT＝26.5 U/L和HBV DNA=3.3 lgIU/ml为截断点,其联合评估肝组织学显著病变的AUC为0.969,其灵敏度和特异度分别为88.6%和95.9%,显著优于两项指标单独评估(P＜0.05)。结论对于30岁以下成人血清ALT正常的慢性HBV感染者,如果血清ALT水平≥27 U/L且HBV DNA≥2000 IU/ml时,是否需要启动抗病毒治疗,值得研究。

关键词: 慢性乙型肝炎, 丙氨酸氨基转移酶, HBV DNA, 肝组织学, 病毒携带者

Abstract: Objective The aim of this study was to investigate the hepatic histological changes in adult individuals under 30 years old with chronic hepatitis B viral infection with normal serum alanine aminotransferase (ALT) levels. Methods A total of 108 individuals under 30 years old with chronic hepatitis B viral infection and with normal ALT levels were enrolled in our hospital between 2013 and 2023, and all underwent liver biopsies. The chronic hepatitis B was diagnosed based on the finding of liver histological activity index ≥G2 and/or liver fibrosis stage ≥S2, and those were classified into chronic HBV carriers who didn’t meet the requirement of CHB. The binary Logistic regression analysis was applied to screen the predictors of significant liver injuries, and the area under receiver operating characteristic curve (AUC) was used to predict the relevant indicators for significant liver inflammatory and fibrotic lesions. Results Out of the 108 individuals with chronic HBV infection, the liver histo-pathological examination found G1S1 in 73 cases, e.g., the HBV carriers, and G2/S2 in 30 cases and G3/S3 in 5 cases, e.g., the CHB in 35 cases; 65.7% of patients with CHB had positive hepatitis B viral infection family history, much higher than 13.7%(P＜0.05) in HBV carriers, and serum ALT level and HBV DNA load in patients with CHB were (30.3±6.7)U/L and 4.4(3.7, 5.8)lg IU/ml, both significantly higher than [(20.2±8.8)U/L and 3.5(2.9, 5.4) lgIU/ml, respectively, P＜0.05] in HBV carriers; the multivariate Logistic analysis showed that serum ALT level and HBV DNA load were the independent indicators for predicting significant liver injuries (P＜0.05); the AUC was 0.969, with the sensitivity and specificity of 88.6% and 95.9%, when the combination of serum ALT (the cut-off-value was 26.5 U/L) and HBV DNA load (the cut-off-value was 3.3 lgIU/ml) were applied to predict significant liver injuries, much superior to any of the two parameters alone (P＜0.05). Conclusion In adults under 30 years old with chronic HBV infection with normal serum ALT levels, when serum ALT level is greater than 27 U/L and serum HBV DNA load is greater than 2000 IU/ml, whether or not the antiviral therapy is given is worthy of further study.

Key words: Hepatitis B, Alanine aminotransferase, HBV DNA, Liver histopathology, HBV carriers

尹丹丹, 张瑞珏, 王帅, 代爱军, 周正, 张帆. 30岁以下血清ALT正常的成人慢性HBV感染者肝组织学变化研究[J]. 实用肝脏病杂志, 2024, 27(3): 341-344.

Yin Dandan, Zhang Ruijue, Wang Shuai, et al. Hepatic histological changes in adult individuals under 30 years old with chronic hepatitis B viral infection with normal serum ALT levels[J]. Journal of Practical Hepatology, 2024, 27(3): 341-344.

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