肝活组织检查确诊乙型肝炎肝硬化的临床高危因素分析

施梅姐; 张朝臻; 池晓玲; 谢玉宝; 萧焕明

doi:10.3969/j.issn.1001-5256.2014.02.013

肝活组织检查确诊乙型肝炎肝硬化的临床高危因素分析

DOI: 10.3969/j.issn.1001-5256.2014.02.013

广东省中医院肝病科

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中图分类号: R512.62
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出版历程
- 出版日期: 2014-02-20

Analysis of clinical high-risk factors for hepatitis B cirrhosis confirmed by liver biopsy

摘要

摘要:
目的分析由肝活组织检查确诊乙型肝炎肝硬化的临床高危因素。方法采用1∶2配比的病例对照研究设计。收集2009年4月-2012年10月住院并行肝活组织检查的慢性乙型肝炎（CHB）患者的临床资料,将其中乙型肝炎肝硬化患者79例设为病例组（肝硬化组）;同期住院的CHB非肝硬化患者158例设为对照组（非肝硬化组）。对2组的临床相关因素进行单因素分析及Logistic多因素回归分析。单因素分析中,计数资料比较采用卡方检验,计量资料采用t检验。然后选择有统计学意义的指标进行Logistic多因素回归分析。结果单因素分析显示肝硬化组的男性例数、HBeAg阴性例数、年龄、AST、GGT、IgG、透明质酸（HA）水平明显高于非肝硬化组,而Alb、PLT、HBV DNA、层粘连蛋白（LN）水平肝硬化组明显低于非肝硬化组,2组差异均有统计学意义（P均<0.05）。以是否肝硬化为因变量,以其他因素为自变量,进行非条件的Logistic多因素回归分析,结果显示年龄增大（β=0.046,OR=0.955）、GGT升高（β=0.040,OR=0.960）、IgG升高（β=0.179,OR=0.836）是发生肝硬...
- 活组织检查 /
- 肝硬化 /
- 肝炎,乙型,慢性 /
- 危险因素
Abstract:
Objective To analyze the clinical high- risk factors for hepatitis B cirrhosis confirmed by liver biopsy. Methods A case- control study was conducted on the clinical data collected from 237 patients with chronic hepatitis B who were hospitalized and underwent biopsy from April 2009 to October 2012. These patients included 79 cases confirmed by liver biopsy as having liver cirrhosis ( case group) and 158 cases confirmed by biopsy as not having liver cirrhosis ( control group) . Univariate analysis and multivariate logistic regression analysis were used to investigate the clinical risk factors for liver cirrhosis. In the univariate analysis, comparison of categorical data was made by chi- square test, and comparison of continuous data was made by t test. The indices of statistical significance were subjected to multivariate logistic regression analysis. Results The univariate analysis showed that the case group had significantly increased numbers of male cases and HBeAg- negative cases, age, and aspartate aminotransferase ( AST) , gamma- glutamyl transpeptidase ( GGT) , immunoglobulin G ( IgG) , and hyaluronic acid levels ( P < 0. 05) and significantly decreased albumin ( Alb) , hepatitis B virus DNA, and laminin levels and platelet ( PLT) count ( P < 0. 05) , as compared with the control group. The unconditional multivariate logistic regression analysis showed that increasing age [β = 0. 046, odds ratio ( OR) = 0. 955], elevated GGT level ( β = 0. 04, OR = 0. 96) , and increased IgG level ( β = 0. 179, OR = 0. 836) were high- risk factors for liver cirrhosis, while increased Alb level ( β =- 0. 114, OR = 1. 120) and PLT count ( β =- 0. 024, OR = 1. 024) were protective factors for liver cirrhosis. Conclusion Increasing age, decreased Alb level, elevated GGT level, decreased PLT count, and increased IgG level are high- risk factors for liver cirrhosis in patients with chronic hepatitis B whose ALT levels range within 0- 80 U / L. Active monitoring of the above indices, especially PLT, IgG, and GGT, and liver biopsy should be performed if necessary to avoid misdiagnosis of liver cirrhosis in patients with chronic hepatitis B.
- biopsy /
- liver cirrhosis /
- hepatitis B, chronic /
- risk factors

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参考文献(12)

[1]GENG XX, LIN JM, YANG XX, et al.Liver histopathology andclinical manifestations in patients with chronic HBV infection:an analysis of 128 cases[J].World J Gastroenterol, 2009, 17 (20) :2099-2104. (in Chinese) 耿晓霞, 林健梅, 杨兴祥, 等.慢性HBV感染者肝脏病理及临床特征分析128例[J].世界华人消化杂志, 2009, 17 (20) :2099-2104.

[2]LING QH, CHEN JJ, CHEN YY, et al.The histopathological manifestations in individuals with hepatitis B viral carriers[J].J Clin Hepatol, 2011, 14 (1) :18-20. (in Chinese) 凌琪华, 陈建杰, 陈逸云, 等.肝活检对HBV携带者的诊断意义[J].实用肝脏病杂志, 2011, 14 (1) :18-20.

[3]ALAM S, AHMAD N, MUSTAFAG, et al.Evaluation of normal or minimally elevated alanine transaminase, age and DNA level in predicting liver histological changes in chronic hepatitis B[J].Liver Int, 2011, 31 (6) :824-830.

[4]DOU XG.Anti-virus treatment strategies for chronic hepatitis B virus infection with normal alanine aminotransferase[J].Chin J Pract Intern Med, 2013, 33 (6) :454-456. (in Chinese) 窦晓光.丙氨酸转氨酶正常的慢性乙型肝炎病毒感染人群抗病毒治疗策略[J].中国实用内科杂志, 2013, 33 (6) :454-456.

[5] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 version) .J Clin Hepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会、中华医学会感染病学分.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ.

[6]Chinese Society of Infectious Diseases and parasitology, Chinese Society of Hepatology, Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Hepatol, 2000, 8 (6) :324-329. (in Chinese) 中华医学会传染病与寄生虫病学会、肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329.

[7]Asian Pacific Association for the Study of Liver.Asian-Pacific consensus statement on the management of chronic hepatitis B[J].J Hepatol, 2012, 10 (1007) :2-31.

[8]European Association for the Study of Liver.EASL clinical practice guidelines:management of chronic hepatitis B virus infection[J].J Hepatology, 2012, 57 (1) :167-185.

[9]LI CX, XU GH, PAN HQ, et al.Clinical differences between HBeAg positive and negative chronic hepatitis B patients over 40years old[J].J Clin Hepatol, 2012, 28 (6) :425-427. (in Chinese) 李春霞, 徐光华, 潘怀强, 等.40岁以上HBeAg阳性和阴性慢性乙型肝炎病毒感染者的临床特点比较[J].临床肝胆病杂志, 2012, 28 (6) :425-427.

[10]LIAO BL, LIN SW, ZHANG FC, et al.Correlation of ALT, HBV DNA, and serum markers of fibrosis with liver fibrosis in patients with chronic hepatitis B[J].J Clin Hepatol, 2012, 28 (9) :657-660. (in Chinese) 廖宝林, 林思炜, 张复春, 等.慢性乙型肝炎患者ALT、HBV DNA及血清肝纤维化标志物与肝纤维化程度的关系[J].临床肝胆病杂志, 2012, 28 (9) :657-660.

[11]SETO WK, LAI CL, IP PP, et al.A large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B[J].PLoS One, 2012, 7 (2) :e32622.

[12]SHAO J, WEI L, WANG H, et al.Relationships between hepatitis B virus DNA levels and liver histology in patients with chronic hepatitis B[J].World J Gastroenterol, 2007, 13 (14) :2104-2107.

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