摘要
目的分析丙氨酸转氨酶(ALT)正常的慢性乙型肝炎患者肝脏病理炎症及纤维化情况,并探索其与相关临床指标的关系。方法回顾性收集2016年8月至2019年12月就诊于河南省人民医院感染科的721例ALT正常初治慢性乙型肝炎患者,所有患者均进行肝组织穿刺活检。收集患者性别、年龄、肝功能指标、血常规指标、HBsAg水平、HBeAg状态、HBV DNA水平、脾脏厚度及凝血酶原时间,分析患者一般数据情况,分别利用单因素和多因素分析方法确定影响患者肝穿刺炎症纤维化程度的因素,利用受试者操作特征曲线(ROC)评价所建立的多因素预测模型。检验水准取α=0.05。结果721例慢性乙型肝炎患者年龄(36.1±9.7)岁、男女比例1.28/1。721例患者炎症纤维化情况分级主要集中在G1S1(349例)、G1S2(132例)、G2S2(119例)、G2S1(57例);其中G1S1有349例(占48.4%),G/S≥2者372例(占51.6%)。主要表现为轻中度炎症及纤维化,重度G/S≥3者仅64例(占8.88%)。分析721例患者相关临床指标分层与肝病理炎症和纤维化的关系,其中仅HBsAg水平(以4 log10 IU/ml为界限分层)差异有统计学意义(炎症分级χ^(2)=6.182,P=0.013,纤维化分级χ^(2)=36.534,P=0.001)。对可能影响患者肝组织病理G/S≥2的相关临床指标进行单因素分析,显示患者的年龄、白蛋白、γ-谷氨酰转移酶(GGT)、血小板、凝血酶原时间(PT)、脾脏厚度及HBsAg水平比较均有统计学意义(P值均<0.05);进一步进行多因素分析,结果显示年龄、GGT、PT、脾脏厚度差异均有统计学差异(P值均<0.05)。根据多因素分析建立预测模型,并绘制的ROC曲线下面积为0.642,取灵敏度与特异度之和最大时的点截断值Logit P=0.497,诊断灵敏度为60.6%,诊断特异度为64.5%,约登指数为0.252。结论ALT正常慢性乙型肝炎患者超过半数存在明显炎症及纤维化,需要及时抗病毒治疗。其中年龄、GGT、PT及脾脏厚度可帮助综合评估患者肝脏炎症和纤维化状态,但缺少准确的预测模型,提示更多的有助于预测此类患者炎症和纤维化状态的有效指标尚待发掘,对于ALT正常患者仍要积极进行肝穿刺活检以明确诊断及时治疗。
Objective To analyze the hepatic pathological inflammation and fibrosis condition in order to explore the relationship with related clinical indicators in patients with chronic hepatitis B patients with normal alanine aminotransferase(ALT).Methods 721 cases of chronic hepatitis B with normal ALT who were initially diagnosed in the Department of Infectious Diseases of Henan Provincial People's Hospital from August 2016 to December 2019 were retrospectively collected.Liver biopsy was performed in all patients.General data of patients such as gender,age,liver function indexes,blood routine indexes,HBsAg level,HBeAg status,HBV DNA level,spleen thickness and prothrombin time were collected.Univariate and multivariate analysis methods were used to determine the influencing factors of inflammation and fibrosis degree with liver biopsy.A receiver operating characteristic curve(ROC)was used to evaluate the established multi-factor prediction model.Alpha=0.05 was considered as a standard orientation of test.Results The average age of 721 cases with chronic hepatitis B was 36.1±9.7 years,and the male to female ratio was 1.28/1,with inflammation and fibrosis grade mainly concentrated in G1S1(349 cases),G1S2(132 cases),G2S2(119 cases),and G2S1(57 cases).Among them,there were 349(48.4%)cases of G1S1,and 372(51.6%)cases of G/S≥2.The main manifestations were mild to moderate inflammation and fibrosis,and only 64(8.88%)cases had severe G/S≥3.HBsAg level(stratified with 4 log10 IU/ml as the boundary)analyzed in 721 cases were correlated with the relevant clinical indicators stratification and liver pathological inflammation and fibrosis,and the difference was statistically significant(inflammation grade,χ^(2)=6.182,P=0.013;Fibrosis grade,χ^(2)=36.534,P=0.001).Univariate analysis of the relevant clinical indicators that may influence the patient's liver pathological G/S≥2 showed the patient's age,albumin,γ-glutamyltransferase(GGT),platelet,prothrombin time(PT),spleen thickness and HBsAg level were all statistically significant(P<0.05),while multivariate analysis showed that age,GGT,PT,and spleen thickness had statistical differences(P<0.05).The prediction model was established in accordance to multivariate analysis,and the area under the ROC curve was 0.642.Maximization of the sum of sensitivity and specificity as cut-off value of Logit P=0.497,the diagnostic sensitivity,specificity,and Youden's index were 60.6%,64.5%,and 0.252,respectively.Conclusion More than half of patients with chronic hepatitis B with normal ALT have significant inflammation and fibrosis and require timely antiviral therapy.Age,GGT,PT and spleen thickness can help comprehensively evaluate the liver inflammation and fibrosis status among patients,but the lack of accurate prediction models suggests that more effective indicators that can help predict the inflammation and fibrosis status of such patients have yet to be discovered.Therefore,liver biopsy should still be actively performed in patients with normal ALT to confirm the diagnosis and timely treatment.
作者
宁会彬
靳慧鸣
李宽
彭真
尚佳
Ning Huibin;Jin Huiming;Li Kuan;Peng Zhen;Shang Jia(Department of Infectious Diseases,Henan Provincal People's Hospital,Zhengzhou University People's Hospital,Zhengzhou 450000,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2022年第7期746-751,共6页
Chinese Journal of Hepatology
关键词
慢性乙型肝炎
肝脏病理
炎症
纤维化
抗病毒治疗
Chronic hepatitis B
Liver histopathology
Inflammatory
Fibrosis
Antiviral therapy
