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ALT正常的HBeAg阳性高病毒载量慢性HBV感染者明显肝组织学改变的独立预测因素
Independent predictive factors for significant liver histological changes in patients with HBeAg-positive high-viral-load chronic HBV infection and a normal alanine aminotransferase level
文章发布日期:2016年06月08日  来源:  作者:李强,黄玉仙,陈良  点击次数:631次  下载次数:167次

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【摘要】:目的探索ALT正常的HBeAg阳性高病毒载量慢性HBV感染者明显肝组织学改变(SLHC)的独立预测因素。方法回顾性分析2013年6月-2015年8月于复旦大学附属公共卫生临床中心住院的116例初治ALT正常的(<50 U/L)HBeAg阳性高病毒载量(HBV DNA≥105 拷贝/ml)慢性HBV感染者临床资料。SLHC定义为炎症≥G2和(或)纤维化≥S2。计量资料组间比较采用t检验或Mann-Whitney U秩和检验,计数资料组间比较采用χ2检验。采用单因素、多因素回归分析筛查SLHC的独立预测因素。结果116例患者中47例(40.5%)伴SLHC。多因素分析发现年龄、ALT和GGT是ALT正常的HBeAg阳性高病毒载量慢性HBV感染者伴SLHC的独立预测因素(比值比分别为2.828、1.011、1.089,P值均<0.05)。年龄≤30岁患者SLHC发生率低于年龄>30岁患者(21.6% vs 49.4%, χ2=6.42,P=0.015);ALT≤30 U/L患者SLHC发生率低于30 U/L<ALT≤50 U/L组(17.6% vs 50.0%, χ2=19.86,P<0.001);GGT≤40 U/L患者SLHC发生率低于GGT>40 U/L组(28.8% vs 66.7%, χ2=28.63,P=0002)。结论ALT正常的高病毒载量HBeAg阳性慢性HBV感染者中,年龄>30岁、ALT>30 U/L、GGT>40 U/L的患者伴SLHC的可能性更大,更加迫切需要肝穿刺病理组织学评估。
【Abstract】:ObjectiveTo investigate the independent predictive factors for significant liver histological changes (SLHCs) in patients with HBeAg-positive high-viral-load chronic hepatitis B virus (HBV) infection and a normal alanine aminotransferase (ALT) level. MethodsA retrospective analysis was performed on the clinical data of 116 previously untreated patients with HBeAg-positive high-viral-load (HBV DNA≥105 copies/ml) chronic HBV infection and a normal ALT level (<50 U/L) who were hospitalized in Shanghai Public Health Clinical Center Affiliated to Fudan University from June 2013 to August 2015. The definition of SLHCs was inflammation ≥G2 and/or fibrosis≥S2. The t-test or Mann-Whitney U rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Univariate and multivariate regression analyses were used to determine independent predictive factors for SLHCs. ResultsOf all the 116 patients, 47(40.5%) had SLHCs. The multivariate analysis showed that age (OR=2.828, P<0.05), ALT (OR=1.011, P<0.05), and gamma-glutamyl transpeptidase (GGT) (OR=1.089, P<0.05) were independent predictors for SLHCs in patients with HBeAg-positive high-viral-load chronic HBV infection and a normal ALT level. The patients aged ≤30 years had a significantly lower incidence rate of SLHCs than those aged>30 years (21.6% vs 49.4%, χ2=6.42, P=0.015), the patients with ALT ≤30 U/L had a significantly lower incidence rate of SLHCs than those with 30 U/L<ALT≤50 U/L (17.6% vs 50.0%, χ2=19.86, P<0.001), and the patients with GGT≤40 U/L had a significantly lower incidence rate of SLHCs than those with GGT>40 U/L (28.8% vs 66.7%, χ2=28.63, P<0.001). ConclusionIn patients with HBeAg-positive high-viral-load chronic HBV infection and a normal ALT level, those with an age of>30 years, ALT>30 U/L, and GGT>40 U/L tend to develop SLHCs and need liver biopsy.
【关键字】:肝炎病毒, 乙型; 肝炎e抗原, 乙型; 丙氨酸转氨酶; 病毒载量; 危险因素
【Key words】:hepatitis B virus; hepatitis B e antigens; alanine transaminase; viral load; risk factors
【引证本文】:李强, 黄玉仙, 陈良. ALT正常的HBeAg阳性高病毒载量慢性HBV感染者明显肝组织学改变的独立预测因素[J]. 临床肝胆病杂志, 2016, 32(7): 1310-1314.

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