HBV DNA低水平患者肝组织炎症活动度和纤维化程度的影响因素分析

刘立; 李俊义; 杜映荣; 黄红丽; 罗煜; 李惠敏; 李卫昆; 王霖; 刘春云

doi:10.3969/j.issn.1001-5256.2019.05.010

HBV DNA低水平患者肝组织炎症活动度和纤维化程度的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2019.05.010

1. 昆明市第三人民医院肝三科
2. 昆明市第三人民医院普内科
3. 昆明市第三人民医院肿瘤科
4. 昆明市第三人民医院病理科

基金项目:

云南省科技厅应用基础研究项目(2017FH001-088)；昆明市科技局科技计划项目(2017KJJH252)；

详细信息

中图分类号: R512.62
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出版历程
- 收稿日期: 2018-10-26
- 出版日期: 2019-05-20

Influencing factors for liver inflammation grade and fibrosis degree in patients with low-level HBV DNA

Third Department of Hepatology, The Third People's Hospital of Kunming

Research funding:

摘要

摘要: 目的分析HBV DNA低水平患者肝组织病理特征及相关因素,为HBV DNA低水平患者的病情判断提供依据。方法选取2014年1月-2017年12月于云南省昆明市第三人民医院就诊的HBV DNA> 20 IU/ml且<2000 IU/ml者137例,对患者肝组织行病理检查,炎症分级:G1 44例,G2 84例,G3 9例;纤维化分期:S0 2例,S1 67例,S2 56例,S3 9例,S4 3例。分析患者肝组织炎症和纤维化程度与年龄、性别、感染HBV时间、血生化、HBsAg水平、HBV DNA等的关系。计量资料多组间比较采用Kruskal Wallis H检验,计数资料组间比较采用χ2检验,使用单因素和多因素单向非条件logistic回归分析肝组织病理炎症活动≥G2和纤维化程度≥S2的影响因素。结果 G1、G2、G3 3组间HBsAg、PLT、脾静脉内径和脾脏厚度比较,差异均有统计学意义（H值分别为7. 135、7.458、7. 588、10. 150,P值均<0. 05）; S0、S1、S2、S3、S4 5组间HBsAg、PLT、门静脉内径、脾静脉...
- 乙型肝炎病毒 /
- 病毒载量 /
- 炎症 /
- 病理学,临床 /
- 危险因素
Abstract: Objective To investigate liver pathological features and related factors in patients with low-level HBV DNA, and to provide a basis for evaluating the conditions of such patients. Methods A total of 137 patients with an HBV DNA level of < 2000 IU/ml and > 20 IU/ml who attended The Third People's Hospital of Kunming from January 2014 to December 2017 were enrolled. Liver pathological examination was performed for all patients. Of all patients, 44 had grade 1 ( G1) liver inflammation, 84 had grade 2 ( G2) liver inflammation, and 9 had grade 3 ( G3) liver inflammation; as for fibrosis stage, 2 had S0 fibrosis, 67 had S1 fibrosis, 56 had S2 fibrosis, 9 had S3 fibrosis, and 3 had S4 fibrosis. The correlation of liver inflammation grade and fibrosis stage with age, sex, duration of HBV infection, blood biochemistry, HBsAg level, and HBV DNA was analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and univariate and multivariate one-way non-conditional logistic regression analyses were used to investigate the influencing factors for ≥G2 liver inflammation and ≥S2 fibrosis. Results There were significant differences in HBsAg, platelet count ( PLT) , diameter of the splenic vein, and spleen thickness between the G1, G2, and G3 groups ( H = 7. 135, 7. 458, 7. 588, and 10. 150, all P < 0. 05) , and there were also significant differences in HBsAg, PLT, diameter of the portal vein, diameter of the splenic vein, and spleen thickness between the S0, S1, S2, S3, and S4 groups ( H = 20. 564, 12. 065, 26. 171, 14. 720, and 13. 725, all P < 0. 05) . Of all 137 patients, 44 had no or mild inflammation and necrosis ( < G2 group) and 93 had moderate or severe inflammation and necrosis ( ≥G2 group) ; age, alanine aminotransferase, alkaline phosphatase ( ALP) , white blood cell count, diameter of the splenic vein, and spleen thickness, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis ( α = 0. 15) , and the results showed that age ( odds ratio [OR]= 1. 045, P < 0. 05) , ALP ( OR = 1. 019, P < 0. 05) , and spleen thickness ( OR = 1. 150, P < 0. 05) were independent risk factors for ≥G2 liver inflammation in the patients with low-level HBV DNA. Of all 137 patients, 69 had no or mild liver fibrosis ( < S2 group) and 68 had moderate or severe liver fibrosis ( ≥S2 group) ; total bilirubin, HBsAg, PLT, and diameter of the portal vein, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis ( α = 0. 15) , and the results showed that HBsAg ( OR = 2. 065) , PLT ( OR = 0. 988) , and diameter of the portal vein ( OR = 2. 464) were independent risk factors for ≥S2 liver fibrosis in the patients with low-level HBV DNA. Conclusion The majority of patients with low-level HBV DNA have the indication of antiviral therapy. Age, ALP, and spleen thickness are closely associated with liver inflammation grade in patients with low-level HBV DNA, and HBsAg, PLT, and diameter of the portal vein are closely associated with liver fibrosis.
- hepatitis B virus /
- viral load /
- inflammation /
- pathology, clinical /
- risk factors

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参考文献(15)

[1] CHAN HL, WONG VW, WONG GL, et al. A longitudinal study on the natural history of serum hepatitis B surface antigen changes in chronic hepatitis B[J]. Hepatology, 2010, 52 (4) :1232-1241.

[2] THOMPSON AJ, NGUYEN T, LSER D, et al. Serum hepatitis B surface antigen and hepatitis B e antigen titers:Disease phase influences correlation with viral load and intra-hepatic hepatitis B virus markers[J]. Hepatology, 2010, 51 (6) :1933-1944.

[3] MONTAZERI G, RAHBAN M, MOHAMADNEJAD M, et al. Liver histology and HBV DN levels in chronically HBV infected patients with persistently normal alanine aminotransferase[J].Arch Iran Med, 2010, 13 (3) :193-202.

[4] MACMAHON BJ. The natural history of chronic hepatitis B virus infection[J]. Hepatology, 2009, 49:45.

[5] Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medcal Association. The guideline of prevention and treatment for chronic hepatitis B (2015 version) [J]. J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[6] TSENG TC, LIU CJ, YANG HC, et al. Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus loads[J]. Hepatology, 2013, 57 (2) :441-450.

[7] European Association for the Study of the Liver. EASL clinical practice guidelines:management of chronic hepatitis B virus infection[J]. Hepatel, 2012, 57 (1) :167-185.

[8] TRAN TT. Immune tolerant hepatitis B:A clinical dilemma[J].Gastroenterol Hepal, 2011, 7 (8) :511-516.

[9] QIU HF, LI JH, YANG WJ, et al. Analysis of related factors of ALT persistently normal patients with chronic HBV infection[J]. Chin J Nosocomiol, 2015, 25 (17) :3893-3895. (in Chinese) 邱惠芳, 李金花, 杨文君, 等.慢性乙型肝炎感染谷丙转氨酶持续正常患者肝脏病理相关因素分析[J].中华医院感染杂志, 2015, 25 (17) :3893-3895.

[10] LI W, XU KH, ZHAO SS. Association between liver pathology and clinical features in patients with chronic HBV infection and slightly elevated alanine aminotransferase[J]. J Clin Hepatol, 2017, 33 (11) :2123-2126. (in Chinese) 李伟, 徐葵花, 赵守松. ALT轻度升高的慢性HBV感染者临床特征与病理学的关系[J].临床肝胆病杂志, 2017, 33 (11) :2123-2126.

[11] DING HB, LI YX, LAI JQ, et al. Correlation between pathological changes of liver tissue and portal vein diameter in patients with chronic hepatitis B[J]. J Prac Hepatol, 2010, 13 (5) :369-370. (in Chinese) 丁红兵, 李奕鑫, 赖江琼, 等.慢性乙型肝炎患者肝组织病理学改变与门静脉内径的相关性分析[J].实用肝脏病杂志, 2010, 13 (5) :369-370.

[12] HUO XP, XIE QX, JIANG XP, et al. Pathological changes of liver tissues in 486 patients with chronic hepatitis B[J]. J Prac Hepatol, 2015, 18 (4) :360-363. (in Chinese) 霍雪平, 谢琴秀, 江晓平, 等. 486例慢性乙型肝炎患者肝组织病理学变化与肝功能指标的相关性研究[J].实用肝脏病杂志, 2015, 18 (4) :360-363.

[13] SUN HY, WANG M, LYU SJ, et al. Predictive factors of early diagnosis of liver cirrhosis in chronic HBV carriers[J/CD].Chin J Liver Dis:Electronic Edit, 2017, 9 (4) :82-85. (in Chinese) 孙海英, 王明, 吕胜军, 等.慢性HBV携带者早期肝硬化诊断的预测因素分析[J/CD].中国肝脏病杂志:电子版, 2017, 9 (4) :82-85.

[14] HUANG CM, YANG Z, NIE YQ, et al. Value of gamma-glutamyl transpeptidase-to-platelet ratioin predicting liver fibrosis stage in chronic hepatitis B patients in Guangdong, China[J]. J Clin Hepatol, 2018, 34 (6) :1204-1208. (in Chinese) 黄春明, 杨湛, 聂玉强, 等. GGT/PLT比值对广东地区慢性乙型肝炎患者肝纤维化分期的预测价值[J].临床肝胆病杂志, 2018, 34 (6) :1204-1208.

[15] LU HY, LIU LF, XU XY, et al. FibroScan in diagnosis of liver fibrosis in patients with different chronic liver diseases:A comparative analysis[J]. J Clin Hepatol, 2016, 32 (8) :1512-1517. (in Chinese) .陆海英, 刘玲峰, 徐小元, 等. FibroScan诊断不同类型慢性肝病肝纤维化的效果比较[J].临床肝胆病杂志, 2016, 32 (8) :1513-1517.

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