摘要
目的分析HBV DNA低载量HBsAg阳性患者转氨酶异常的原因。方法研究对象为血清HBsAg阳性时间持续1年以上、HBV DNA（PCR法）〈10^3拷贝／ml和ALT〉1．25×ULN超过6个月的患者，剔除合并HCV和HIV等病毒感染及其他漫性肝病。患者均进行肝活组织检查并结合临床资料分析转氨酶增高的原因。结果有119例患者纳入研究，男性102例，HBeAg阴性88例（73．9％）；平均年龄（33．9±9．7）岁，体重指数（23．4±3．7）kg／m^2，ALT（150．0±166．6）U／L，AST（102．4±193．2）U／L。肝活组织检查有32例（26．9％）为肝细胞脂肪变，64例（53．8％）为慢性肝炎，7例（5．9％）为两者并存，15例（12．6％）为非特异性改变，1例为正常肝组织。30例接受核苷类似物抗病毒治疗的患者，17例有肝脂肪变，占56．7％；89例未进行抗病毒治疗的患者，有22例有肝脂肪变，占24．7％，两组比较x^2=10．394，P〈0．01，差异有统计学意义。单因素分析显示，肝脂肪变组（n=39）体重指数、甘油三酯、总胆固醇、载脂蛋白B以及尿酸水平显著高于无肝脂肪变组（n=64）；而ALT、AST和载脂蛋白-A水平则显著低于无肝脂肪变组，t值分别为5．369、4．276、3．216、4．223、2．438以及-2．234、-3．877和-2．956，P值均〈0．05。肝脂肪变组男性的比例、超重和肥胖、高尿酸血症和高脂血症的患病率亦显著高于无肝脂肪变组；而肝组织炎症和纤维化程度却显著降低，x^2分别为3．829、7．659、13．389、0．549和20．978、17．550，P直均〈0．05。与肝脏非特异性改变患者相比较，慢性肝炎患者ALT、AST、GGT水平显著升高，P值均〈0．05；但其他相关指标无统计学差异。结论代谢紊乱及其相关肝细胞脂肪变为HBV DNA低载量HBsAg阳性患者转氨酶升高的原因之一。
Objective To evaluate the causes of alanine aminotransferase （ALT） level elevation in HBsAg-positive chronic hepatitis B （CHB） patients with low HBV DNA loads. Methods One hundred nineteen HBsAg positive CHB patients with both serum HBV DNA loads 〈 103 copies/ml and ALT〉1.25 upper limits of normal （ULN） lasting for at least 6 months were enrolled in this study. Patients co-infected with hepatitis C virus or HIV or suffering from other liver diseases were not included. HBV DNA loads were assayed by PCR. Serological biochemistry and liver biopsy histopathological changes and clinical characteristics of the patients were analyzed. Results Of the 119 patients 102 were males and 17 were females. The mean age of the patients was （33.9±9.7） years and their body mass index （BMI） was （23.4±3.7） kg/m2. Mean ALT levels were （150.0±166.6） U/L and AST levels were （102.4±193.2） U/L. Liver biopsies showed hepatic steatosis in 26.9 % （32/119） of the cases, chronic hepatitis in 53.8% （64/119）, non-specific changes in 12.6% （15/119）, and 1 without any change. However, hepatic steatosis was more frequently seen in patients taking nucleoside analogs （56.7%）, x^2 = 10.394, P 〈 0.01. BMI, apolipoprotein B （APO-B）, triglyceride, cholesterol and uric acid were all significantly higher in patients with hepatic steatosis than those without （t values were 5.369, 4.276, 3.216, 4.223 and 2.438 respectively, all P 〈 0.05） while ALT, AST and apolipoprotein A were much lower in those with steatosis than those without （t values were -2.234, -3.877 and -2.956 respectively, all P 〈 0.05）. Obesity, dyslipidemia and hyperuricemia were more frequently seen in patients with steatosis than in patients without it （ x^2 value 3.829, 7.659, 13.389, 0.549, all P 〈 0.05）. The severity of inflammation and fibrosis were also more significant in patients with steatosis （ x^2 value 20.978, 17.550, all P 〈 0.05）. As compared to those patients without specific changes, serum levels of ALT, AST, GGT in patients with chronic hepatitis were obviously higher, all P 〈 0.05. In contrast, there were no significant differences in mean age, BMI, male preference, obesity, diabates, dyslipidemia or hyperuricemia, and the levels of triglyceride, cholesterol, and fasting plasma glucose between the two groups. Conclusion Our data indicate that hepatic steatosis might be a factor associated with elevated ALT levels in HBsAg-positive CHB patients with low HBV DNA loads, especially in patients treated with nucleoside analogs.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2008年第11期818-822,共5页
Chinese Journal of Hepatology
