摘要
目的探讨血清HBs Ag低水平的慢性乙型肝炎患者肝组织炎症活动和纤维化分期的相关影响因素。方法 2016年3月~2018年3月我院诊治的70例血清HBs Ag低水平慢性乙型肝炎患者,行肝活检检查,采用Scheuer法对肝组织进行炎症分级和纤维化分期,采用单因素和多因素回归分析影响肝组织炎症活动和纤维化分期的因素。结果本组肝组织无明显炎症(G0-G1)者26例(37.1%),中重度炎症(G2-G3)者44例(62.9%);无/轻度肝纤维化(S0-S1)者37例(52.8%),中重度肝纤维化(S2-S3)者33例(47.2%);经非条件单因素和多因素回归分析,发现感染时间[比值比(OR)=3.245,95%可信区间(CI):1.210~2.012,P=0.035]和脾静脉内径(OR=4.011,95%CI:1.248~6.514,P=0.025)是影响肝组织炎症分级的独立危险因素,而血清天冬氨酸氨基转移酶水平(OR=2.225,95%CI:0.895~1.211,P=0.048)和血小板计数(OR=3.014,95%CI:0.964~1.010,P=0.021)为影响肝纤维化程度的独立危险因素。结论血清HBs Ag低水平的慢性乙型肝炎患者肝组织仍然可能存在明显的炎症和纤维化,需要及时进行肝组织学检查,以明确病变程度,并给予相应的处理,以免延误了病情。
Objective To investigate hepatic activity grading and fibrosis staging in hepatitis B patients with low serum hepatitis B surface antigen levels.Methods Seventy patients with low serum HBs Ag levels were recruited in our hospital between March 2016 and March 2018.The liver biopsies were performed in all patients,and the Scheuer＇s hepatic activity index was applied to determine the hepatic inflammation grade and fibrosis stage.Univariate and multivariate regression analysis was used to analyze the influencing factors.Results There were 26 patients（37.1%） without or with mild hepatic inflammatory grading（G0-G1）,and 44 patients（62.9%）with moderate to severe inflammatory grading（G2-G3）,and there were 37 patients（52.8%） without or with mild hepatic fibrosis（S0-S1） and 33 patients（47.2%） with moderate to severe hepatic fibrosis（S2-S3）;univariate and multivariate regression analysis showed that the duration of infection [OR =3.245,95 % confidence interval（CI）：1.210-2.012,P=0.035] and splenic vein diameter（OR=4.011,95% CI：1.248-6.514,P=0.025） were the independent risk factors affecting hepatic activity grading,and serum aspartate aminotransferase level（OR=2.225,95% CI：0.895-1.211,P=0.048） and platelet counts（OR=3.014,95% CI：0.964-1.010,P=0.021） were the independent risk factors affecting liver fibrosis.Conclusion The hepatic activity index might be increased in CHB patients with low serum HBs Ag levels,suggesting that they should be given much more medical attention for appropriate management in time.
作者
赵明英
李春林
Zhao Mingying;Li Chunlin(Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)
出处
《实用肝脏病杂志》
CAS
2018年第5期725-728,共4页
Journal of Practical Hepatology
基金
四川省医学会青年创新课题(编号:Q150035)
