慢性乙肝病毒携带者血清ALT、AST及HBVM与肝组织病理的关系

Relationship between Serous Expression of ALT, AST, HBVM and Hepatic Pathologic Impairment of Patients with Chronic HBV Carriers Infection

作者: 专业:传染病学 导师:苏明华 年度:2011 学位:硕士  院校: 广西医科大学

Keywords

Chronic hepatitis B virus carriers, Liver pathology, ALT, AST, HBV-DNA

        目的分析慢性乙肝病毒携带者(慢性HBV携带者)的肝组织病理特点及血清丙氨酸氨基转移酶(alanine aminotransferase, ALT).天冬氨酸氨基转移酶(aspartate aminotransferase, AST)及乙肝病毒标志物与肝组织病理的关系。方法检测50例慢性HBV携带者、21例非活动性HBsAg携带者、20例ALT水平在40-80U/L之间的慢性乙型肝炎(轻度慢性乙型肝炎)患者的血清乙肝标志物、肝功能及血清HBV-DNA水平。所有病例均在B超引导下进行肝穿刺病理活检,并进行肝组织炎症活动度(G)分度及纤维化程度分期(S)。分析ALT、AST、HBeAg及HBV-DNA与肝组织病理的相关性。结果1.50例慢性HBV携带者中G0、G1、G2-4分别占13(26%)、26(52%)及11(22%);与非活动性HBsAg携带者(G0、G1、G2-4分别占9(42.5%)、11(52.4%)及1(4.7%))及轻度慢性乙型肝炎(G0、G1、G2-4分别占5(25%)、8(40%)及7(35%))比较无统计学差异P>0.05;S0、S1、S2-4分别占23(46%),16(32%)及11(22%);与与非活动性HBsAg携带者(S0、S1、S2-4分别占11(52.4%)、9(42.9%)及1(4.7%))及轻度慢性乙型肝炎(S0、S1、S2-4分别占8(40%)、6(30%)及6(30%))比较无统计学差异P>0.05;2.把肝组织炎症活动度G0-4及纤维化分期S0-4-分别计为0、1、2、3、4分,计算三组肝组织炎症活动度及纤维化分期的均值,慢性HBV携带者G均值为1.02±0.45与非活动性HBsAg携带者(0.624-0.59)比较P(0.05;与轻度慢性乙型肝炎(1.15±0.875)比较无统计学差异P>0.05,慢性HBV携带者的S均值(0.864±1.01)与非活动性HBsAg携带者(0.524-0.602)及轻度慢性乙型肝炎(1.05±1.099)比较P>0.05;3.慢性HBV携带者血清ALT. AST、HBeAg及HBV-DNA与肝组织炎症活动度(G)及纤维化分期进行相关性分析均无明显相关性P均>0.05。4.慢性HBV携带者中34例男性患者血清ALT在>30u/L及≤30u/L水平不同组肝组织炎症分级在G2及以上及纤维化分期在S2及以上的差别均无统计学意义(P>0.05)。5.慢性HBV携带者年龄>40岁的纤维化程度较年龄≤40岁纤维化程度重(P<0.05)。结论1.慢性HBV携带者74%有不同程度的肝组织病理损害。2.对于慢性乙肝病毒携带者ALT、AST、HBeAg及HBV-DNA不能很好地反映肝组织的病理改变。3.40岁以上慢性HBV携带者应该给予抗病毒治疗。
    Objective To analyze the pathological features of Liver and the correlation of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), Hepatitis B virus markers with the Liver pathology in patients with hepatitis B virus carriersMethods 50 patients with chronic hepatitis B virus(HBV) carriers, 21 patients with Inactive HBsAg carriers and 20 patients with chronic hepatitis B(which ALT level is 40-80U/L)(Mild chronic hepatitis B) were enrolled in this study.The Serum HBV markers, Liver function and HBV-DNA were detected. Liver biopsies were performed at the same time in all patients and histological grade and stage were evaluated. The relationship between the serum ALT, AST、HBeAg、HBV-DNA and the Liver pathology were analyzed.Results 1. Of 50 patients with chronic HBV carriers, there were 13(26%),26(52%)and 11(22%) cases belong to GO, G1 and G2-4 respectively,23(46%),16(32%) andll(22%) cases belong to SO, S1 and S2-4 respectively. Of 21 patients with Inactive HBsAg carriers, there were 9(42.5%), 11(52.4%)and 1(4.7%) cases belong to GO, G1 and G2-4 respectively,11(52.4%),9(42.9%) and 1(4.7%) cases belong to S0, S1 and S2-4 respectively. Of 20 patients with chronic hepatitis B, there were 5(25%),8(40%)and 7(35%) cases belong to GO, G1 and G2-4 respectively,8(40%),6(30%) and 6(30%) cases belong to SO, S1 and S2-4 respectively.There was no statistical differences in the grades of inflammation and fibrosis between both chronic HBV carriers and Inactive HBsAg carriers group and chronic HBV carriers and Mild chronic hepatitis B group.2.The degree of liver inflammation and fibrosis GO-4 SO-40,1,2,3,4points were calculated, Calculation of three groups with liver inflammation and fibrosis of the mean. Inflammation of the mean G with chronic HBV carriers is (1.02±0.845),and for the Inactive HBsAg carriers group Is (0.62±0.59), Mild chronic hepatitis B group is (1.15±0.875),There was significantly difference in the Inflammation of the mean G between Chronic HBV carriers group and Inactive HBsAg carriers group (P<0.05),but There was no significantly difference between the Chronic HBV carriers group and the Mild chronic hepatitis B group(P>0.05).And the mean S with Chronic HBV carriers group is (0.52±0.602),and for the Inactive HBsAg carriers group is (0.52±0.602), Mild chronic hepatitis B group is (1.05±1.099).There was no significantly difference in the mean S both chronic HBV carriers and Inactive HBsAg carriers group and chronic HBV carriers and Mild chronic hepatitis B group(P>0.05).3. There was no significantly relationship between the serum ALT、AST、HBeAg、HBV-DNA and the grades of liver inflammation and fibrosis with the chronic HBV carriers patients.4.Of 34 male patients with chronic HBV carriers. There was no significantly differences in the grades of inflammation and fibrosis between ALT>30u/L group and ALT≤30 u/L group.5 Of 50 patients with chronic HBV carriers,there was significantly deference in the grades of fibrosis between Younger than 40 years group and older than 40 years group,the latter had a high rate of severe fibrosis.Conclusions 1.For the chronic HBV carriers,even if liver function are normal,74% of them also have different degrees of hepatic pathological damage.2. For chronic HBV carriers ALT, AST, HBeAg,HBV-DNA and liver pathological changes are not totally consistent.3. Chronic HBV carriers which aged over 40 should be given antiviral treatment.
        

慢性乙肝病毒携带者血清ALT、AST及HBVM与肝组织病理的关系

缩略语中英文对照表4-5
摘要5-7
ABSTRACT7-9
前言11-12
资料与方法12-14
结果14-16
讨论16-20
结论20-21
参考文献21-24
综述24-35
    参考文献31-35
致谢35
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