慢性乙型肝炎患者临床和肝组织病理学特点及影响肝纤维化因素分析*

doi:10.3969/j.issn.1672-5069.2018.05.015

实用肝脏病杂志 ›› 2018, Vol. 21 ›› Issue (5): 713-716.doi: 10.3969/j.issn.1672-5069.2018.05.015

慢性乙型肝炎患者临床和肝组织病理学特点及影响肝纤维化因素分析^*

郑珍川, 许夕海

230032 合肥市安徽医科大学第一附属医院感染病科

收稿日期:2018-01-19 出版日期:2018-09-10 发布日期:2018-09-27
通讯作者: 许夕海,E-mail：2xhai@163.com
作者简介:郑珍川，女，32岁，医学硕士。主要从事乙型肝炎防治研究。E-mail：359019097@qq.com
基金资助:
国家自然科学基金资助项目（编号：81673242）; 国家科技重大专项项目（编号：2017ZX10204401-002-006）

Pathological and clinical features and factors affecting significant liver fibrosis in patients with chronic hepatitis B

Zheng Zhenchuan, Xu Xihai.

Department of Infectious Diseases,First Affiliated Hospital,Anhui Medical University,Hefei 230032,Anhui Province,China

Received:2018-01-19 Online:2018-09-10 Published:2018-09-27

摘要/Abstract

摘要： 目的分析HBeAg阴性与阳性慢性乙型肝炎（CHB）患者临床和肝组织病理学特点,探讨影响CHB患者发生明显肝纤维化的危险因素。方法回顾性分析250例CHB患者血清HBV DNA水平、Fibroscan检测肝脏硬度（stiffness）值和肝穿刺组织病理学特点,应用多因素Logistic回归模型分析影响CHB患者发生明显肝纤维化的独立危险因素。结果 160例HBeAg阴性患者血清HBV DNA ≥1×10⁵ copies/ml者所占比例显著低于HBeAg阳性组（66.9%对99.4%,P<0.05）;HBeAg阴性组血清ALT和AST水平显著低于HBeAg阳性组（P<0.05）;血清HBeAg阴性组与阳性组肝组织炎症分级和纤维化分期总体分布差异无统计学意义（P>0.05）;多因素Logistic回归分析结果显示年龄≥40岁、HBV DNA水平高、PTA低和Stiffness水平高为CHB患者存在明显肝纤维化的独立危险因素。结论血清HBeAg阴性与阳性CHB患者存在一些临床和肝组织病理学特征的差异,血清HBeAg阴性患者可能存在更为严重的临床和预后问题,需要给予特别的关注和管理。

关键词: 慢性乙型肝炎, 肝活检, 肝纤维化, 影响因素

Abstract: Objective To investigate the pathological and clinical features and factors affecting significant liver fibrosis in patients with chronic hepatitis B（CHB）. Methods The clinical data and liver biopsies in 250 patients with CHB were analyzed retrospectively,and serum HBV DNA loads and 1iver stiffness measurements were obtained. The factors affecting liver fibrosis was analyzed by Logistic analysis. Results The rate of patients with high serum HBV DNA loads was lower in 160 patients with serum HBeAg negative（66.9% vs. 99.4%, P<0.05） as compared to that in 60 with serum HBeAg positive;serum levels of ALT and AST in patients with serum HbeAg negative were siginificantly lower than in serum HBeAg positive group （P<0.05）;the hepatic activity grading and fibrosis staging in the two groups had no statistically significant differences（P>0.05）;multivariate Logistic regression analysis showed that age ≥40 yr,higher serum HBV DNA loads,lower PTA and high liver stiffness were the independent risk factors for significant liver fibrosis in patients with CHB. Conclusion There are many obvious clinical and histopathological differences in patients with serum HBeAg negative and positive, and the clinicians might take more attention to patients with serum HBeAg negative.

Key words: Hepatitis B, Liver histopathology, Liver fibrosis, Risk factors

郑珍川, 许夕海. 慢性乙型肝炎患者临床和肝组织病理学特点及影响肝纤维化因素分析^*[J]. 实用肝脏病杂志, 2018, 21(5): 713-716.

Zheng Zhenchuan, Xu Xihai.. Pathological and clinical features and factors affecting significant liver fibrosis in patients with chronic hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 713-716.

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慢性乙型肝炎患者临床和肝组织病理学特点及影响肝纤维化因素分析^*

Pathological and clinical features and factors affecting significant liver fibrosis in patients with chronic hepatitis B

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