Clinical features and liver pathology in chronic hepatitis B virus-infected patients with normal liver function
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摘要:
目的了解肝功能正常的慢性HBV感染者的临床特点和肝脏病理学及其影响因素。方法收集2008年8月-2012年8月在江苏大学附属镇江市第三人民医院诊治的肝功能正常的慢性HBV感染者316例,采用超声定位穿刺取肝组织,行HE染色、纤维Masson染色,HBs Ag和抗-HBc免疫组化染色,观察Knodell坏死炎症评分和Ishak纤维化评分,并分别分析其与年龄、性别、HBe Ag状态、ALT水平、血清HBV DNA复制水平以及HBs Ag和HBc Ag肝组织表达的关系。计量资料两组间比较采用t检验,多组间比较采用单因素方差分析,进一步两两比较采用SNK-q检验;计数资料组间比较采用χ2检验。结果肝功能正常的慢性HBV感染者中有260例(82.3%)炎症坏死中度以上,中度纤维化以上有256例(81.0%);重度炎症坏死和重度纤维化(肝硬化)分别为13例(4.1%)和26例(8.2%)。女性平均年龄大于男性(t=3.526,P<0.05),并且其Knodell评分和Ishak评分均高于男性(t值分别为6.65、5.77,P值均<0.05);30岁以上的慢性HBV感染者其Knodell...
Abstract:Objective To study the clinical features and liver pathology in chronic hepatitis B( HBV)-infected patients with normal liver function,and to explore the influencing factors. Methods A total of 316 chronic HBV-infected patients with normal liver function who were admitted to our hospital from August 2008 to August 2012 were enrolled as subjects. Hepatic tissue was collected by ultrasound-guided biopsy and analyzed by hematoxylin-eosin staining,Masson staining,and anti-HBs Ag and anti-HBc Ag immunohistochemistry staining.The Knodell inflammatory score and Ishak fibrosis score were evaluated,and their relationships with age,gender,HBe Ag,alanine aminotransferase( ALT) level,serum HBV DNA replication,and hepatic expression of HBs Ag and HBc Ag were analyzed. Comparisons of continuous data between two groups and between multiple groups were performed by t test and one-way analysis of variance,respectively. The further pairwise comparison was performed by SNK-q test. Comparison of categorical data was performed by χ2test. Results In all the chronic HBV-infected patients with normal liver function,there were 260( 82. 3%) patients with at least moderate inflammation and necrosis,256( 81. 0%) patients with at least moderate fibrosis,13( 4. 1%) patients with severe inflammation and necrosis,and 26( 8. 2%)patients with severe fibrosis( cirrhosis). The average age,Knodell score,and Ishak score were significantly higher in the female patients than in the male patients( t = 3. 526,P < 0. 05; t = 6. 65,P < 0. 05; t = 5. 77,P < 0. 05). The chronic HBV-infected patients older than30 years of age had significantly higher Knodell and Ishak scores than those younger than 30 years of age( both P < 0. 05). Moreover,the degree of liver injury was significantly higher in the infected patients with an ALT level of( 0. 5-1) × upper limit of normal( ULN) than in those with an ALT level of( 0-0. 49) × ULN( P < 0. 05). Patients with undetectable HBV DNA replication had a significantly lower degree of liver injury than those with detectable HBV DNA replication( P < 0. 05). However,there was no significant correlation between liver injury and hepatic expression of HBs Ag and HBc Ag( both P > 0. 05). Conclusion Liver biopsy should be considered for the chronic HBV-infected patients with detectable viral load and sustainable normal ALT,particularly those older than 40 years of age.
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Key words:
- hepatitis B,chronic /
- pathology,clinical /
- liver function tests
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