解放军医学院学报2023，Vol.44Issue(11)：1218-1223,6.DOI:10.12435/j.issn.2095-5227.2023.103
丙氨酸转氨酶正常的慢性乙型肝炎患者肝组织学改变的关联因素分析
Factors associated with liver histological changes in chronic hepatitis B patients with normal alanine transaminase
摘要
Abstract
Background Liver fibrosis or inflammatory reaction may still exist in chronic hepatitis B(CHB)patients with persistent normal alanine transaminase(ALT),and some patients may develop into cirrhosis or liver cancer insidiously.Objective To identify the high-risk factors associated with obvious hepatic fibrosis or inflammation in such patients.Methods Patients with normal ALT and biopsy-proven CHB,admitted to the Fifth Medical Center of Chinese PLA General Hospital from August 2002 to August 2022 were selected from the electronic medical record.Their clinical information was retrospectively retrieved.Hepatic fibrosis(S0-4)and inflammation(G0-4)were evaluated according to Scheuer scoring system.The patients were divided into two groups(with or without obvious liver fibrosis/inflammation)according to the pathological(inflammation or fibrosis)score≥2.Multivariate logistic regression analysis was used to analyze the independent risk factors.Results Totally 1 493 patients were enrolled,with average age of(36.9±11.0)years.Male accounted for 60.5%(903 cases).Among them,608(40.7%)patients presented obvious hepatic fibrosis,and 388(26.0%)patients presented inflammation.Having family history of CHB,＞30 years-old,AST＞1×ULN(upper limit of normal),and PLT≤184×109/L were associated with higher likelihood of obvious fibrosis.HBV DNA between 3.5-8.0 lg IU/mL,AST＞1×ULN,TBIL＞2×ULN,and PLT≤184×109/L were associated with higher likelihoodof obvious hepatic inflammation.Whereas,patients with HBV DNA＞8.0 lg IU/mL had relatively lower likelihood of hepatic fibrosis or inflammation(all P＜0.05).Conclusion An unexpected high proportion of obvious hepatic fibrosis or inflammation still exists in CHB with persistent normal ALT,whose antiviral treatment should be timely initiated based on high-risk factors mentioned above.关键词
丙氨酸转氨酶/乙型肝炎/慢性/肝活检/肝纤维化/抗病毒治疗Key words
alanine transaminase/hepatitis B/chronic/liver biopsy/hepatic fibrosis/antiviral treatment分类
医药卫生引用本文复制引用
付宝云,熊渝婷,王文畅,邓亚,郭畅,杨武才,王春艳,纪冬,王建军..丙氨酸转氨酶正常的慢性乙型肝炎患者肝组织学改变的关联因素分析[J].解放军医学院学报,2023,44(11):1218-1223,6.基金项目
北京市自然科学基金面上项目(7222173) （7222173）
