【摘要】 目的了解慢性乙型肝炎患者常见的肝功能指标与肝组织学之间的关系。方法在486例慢性乙型肝炎患者,行一秒钟快速肝穿刺活检,对病理标本进行组织炎症活动度分级(G)和纤维化程度分期(S),并分别与同期检测的血清肝功能指标和患者的性别、年龄等指标进行统计学分析。对非正态分布的计量资料采用Mann-Whitney U检验,对正态分布的计量资料采用t检验,相关分析采用Spearman’s或Pearson’s双侧检验。结果在486例慢性乙型肝炎患者中,肝组织≥G2者63例(12.96%),≥S2者231例(47.5%);248例HBe Ag阳性患者的年龄为(32.9±10.5)岁,明显低于238例HBe Ag阴性患者[(40.6±9.5)岁,P<0.05],AKP水平为(88.2±37.1)U/L,明显高于HBe Ag阴性患者[(76.4+27.6)U/L,P<0.05];231例肝组织≥S2组年龄、谷草转氨酶(AST)、碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(GGT)和≥G2比例要明显高于245例<S2组,而白蛋白(ALB)低于<S2组(均P<0.05);在丙氨酸氨基转移酶(ALT)<2×ULN患者中,只有ALB(r=-0.276)、AST(r=0.290)、GGT(r=0.273)与肝纤维化分期相关(均P<0.001);在HBe Ag阳性组,AST(r=0.173)和GGT(r=0.293)与炎症坏死明显相关(P<0.05),在HBe Ag阴性组,球蛋白(GLO)与炎症坏死相关(r=0.169,P=0.017)。结论在慢性乙型肝炎患者血清ALT<2×ULN时,血清AST、GGT、ALB水平与肝组织纤维化程度显著相关,而血清ALT和球蛋白水平与其无明显相关;不管是在HBe Ag阳性或阴性患者,当血清ALT<2×ULN时,需行肝组织学检查才能评估病情,而血清ALT水平不具有提示意义;血清球蛋白水平升高可能提示HBe Ag阴性者肝组织存在慢性炎症。更多还原

【Abstract】 Objective To investigate the relationship among serum ALT,AST,GGT,GLO levels and liver tissue injuries in patients with chronic hepatitis B. Methods 486 patients with chronic hepatitis B viral infection were retrospectively analyzed.The histopathologic examinations of liver biopsies were performed in all of them. The liver histological activity index(grading,G) and the fibrotic stage(S) were obtained. And the serum liver function index,the patient’s gender,age and other indicators were also recorded. The data was measured by Mann-Whitney U test,or by using t test,and we used Spearman’s or Pearson’s for correlation analysis. R esults Out of486 patients with chronic hepatitis B,63(12.96%) had liver grading of ≥G2,and 231(47.5%) had liver fibrosis of ≥S2,and the age was significantly lower in 248 HBe Ag-positive group than in 238 HBe Ag-negative group[(32.9±10.5)yr vs.(40.6±9.5)yr,P<0.05],and AKP levels was significantly higher than in HBe Ag-negative group( P<0.05);the serum AST,AKP,GGT levels in patients with liver fibrosis of ≥S2were significantly higher,but serum ALB levels were lower than those in patients with <S2group(P<0.05);in patients with serum ALT levels less than<2 ULN,ALB(r =-0.276)、AST(r =0.290)and GGT(r =0.273) were associated with liver fibrosis stage(P <0.001),and in HBe Ag-positive group,AST(r=0.173)and GGT(r=0.293) also had a positive relationship with inflammation(P<0.05),and GLO was related to liver inflammation in HBe Ag negative group(r=0.169,P=0.017). ConclusionsSerum AST,GGT,ALB levels are associated with liver fibrosis in patients with seerum ALT less than 2 ULN and liver biopsies are strongly recommended in patients serum ALT less than 2 ULN,no matter serum HBe Ag-positive or-negative when antiviral therapy needs to be considered.更多还原