摘要
目的比较分析慢性乙型肝炎(CHB)不同类型抗病毒治疗适应证的临床病理特征及其意义。方法纳入2014年1月至2019年12月861例接受肝活检术、乙型肝炎病毒(HBV)DNA阳性(>30 IU/ml)且符合抗病毒治疗适应证的CHB患者的临床资料,比较分析其肝脏病理学改变及其与临床特征的相关性。据资料不同采用t检验、方差分析、非参数检验、χ^(2)检验、Ridit分析、logistic回归分析进行统计学分析。结果大部分(72.24%)患者存在明显的病理损伤,肝功能正常组的肝纤维化程度高于异常组(P<0.001)。17.54%患者存在肝脂肪变。绝大部分(97.33%)患者肝组织乙型肝炎表面抗原染色阳性,而乙型肝炎核心抗原(HBcAg)染色阳性仅为50.87%。影响肝脏病理严重程度的正相关因素为碱性磷酸酶水平,负相关因素为肝组织HBcAg染色阳性、白蛋白及血小板水平;HBcAg不同染色程度间肝脏炎症活动度和纤维化程度的差异均有统计学意义(χ^(2)值分别为44.142、102.386,P<0.001),以阴性组最严重。结论CHB患者不同类型抗病毒治疗适应证之间的临床病理特征存在差异,肝功能水平与肝脏病理严重程度并不一致,肝组织HBcAg染色阳性及强度、白蛋白及丙氨酸转氨酶水平与疾病严重程度负相关。
Objective To compare and analyze the clinicopathological features and significance for indications of different types of antiviral therapy in chronic hepatitis B(CHB).Methods Clinical data of 861 CHB cases who received liver biopsy,had hepatitis B virus(HBV)DNA-positive(>30 IU/ml)and met the indications for antiviral therapy from January 2014 to December 2019 were included.Liver pathological changes and their correlation with clinical characteristics were compared and analyzed.According to different data,t-test,analysis of variance,nonparametric test,χ^(2)test,Ridit and logistic regression analysis were used for statistical analysis.Results Most of the cases(72.24%)had remarkable pathological damage.The degree of liver fibrosis was higher in the normal than the abnormal group(P<0.001).17.54%cases had hepatic steatosis.The vast majority of cases(97.33%)had positive hepatitis B surface antigen(HBsAg),while only 50.87%had positive hepatitis B core antigen(HBcAg).The positive correlation factors affecting the severity of liver histopathology were alkaline phosphatase level,while the negative correlation factors were positive HBcAg staining,albumin and platelet level.The degree of liver inflammation and fibrosis had statistically significant differences with different HBcAg staining levels(χ^(2)=44.142 and 102.386,respectively;P<0.001),and the severity was more apparent in the negative group.Conclusion There exist differences in clinicopathological features for indications of different types of antiviral therapy in patients with CHB.Liver function test range is inconsistent with degrees of hepatic histological severity.The positive and intensity of liver tissue HBcAg staining,and albumin and alanine aminotransferase levels have negative correlation with disease severity.
作者
蒋素文
胡爱荣
石小军
朱德东
何哲耘
朱陈倩
张露侃
Jiang Suwen;Hu Airong;Shi Xiaojun;Zhu Dedong;He Zheyun;Zhu Chenqian;Zhang Lukan(Ningbo Institute of Liver Diseases,Hwa Mei Hospital,University of Chinese Academy of Sciences(Ningbo No.2 Hospital),Ningbo 315010,China;Medical School of Ningbo University,Ningbo 315211,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2022年第10期1050-1055,共6页
Chinese Journal of Hepatology
基金
浙江省基础公益研究计划项目(LGF18H030012,LGF22H030002)
浙江省医药卫生科技计划项目(2020KY835)
宁波市科技服务业示范项目(2019F1039)。
