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目的:了解慢性乙型肝炎病毒携带者的肝组织病理改变、乙型肝炎再激活率等。方法:对无锡地区220例慢性乙型肝炎病毒携带者进行了为期5年的临床症状、组织学、病毒学及血清病毒标志物等的动态观察研究。结果:220例慢性乙型肝炎病毒携带者按HBeAg阳性和抗-HBe阳性分组,2组炎症活动度轻重进行等级资料的秩和检验,差别有统计学意义(P<0.05),抗-HBe阳性组炎症重于HBeAg阳性组;2组纤维化程度轻重进行秩和检验,差别有统计学意义(P<0.05),抗-HBe阳性组纤维化重于HBeAg阳性组。按年龄分组,<40岁组及≥40岁组,2组间炎症活动度轻(G0-1)重(≥G2)比较,差异无统计学意义(P>0.05)。2组纤维化程度轻(S0-1)重(≥S2)比较,差异有明显统计学意义(P<0.01),≥40岁组纤维化明显重于<40岁组。5年间,220例中有35例出现乙型肝炎再激活,占总数的15.9%(35/220),其中肝脏病理有明显炎症者(≥G2)乙型肝炎再激活率为27%(33/122),而原肝组织炎症为G0～G1者再激活率为2%(2/98),两者比较差异有明显统计学意义(P<0.01),肝脏病理高炎症者(≥G2)再激活率明显高于低炎症者。35例乙型肝炎再激活患者中≥40岁占27例(77.1%),显示年龄与乙型肝炎病毒携带者再激活率有明显相关性(P<0.01),≥40岁组再激活率明显高于<40岁组,而性别与再激活率无相关性。56例行2次肝活检,23例行3次肝活检,原(第1次肝活检)肝组织正常者几年内相对稳定,病理很少变化,原病理炎症较重者不易恢复,但可以在小范围内波动。结论:慢性乙型肝炎病毒携带者肝脏病理55%有明显异常(炎症≥G2),乙型肝炎再激活率与肝脏炎症分级及年龄密切相关。
Objective: To understand the pathological changes of liver tissue of chronic hepatitis B virus carriers, hepatitis B reactivation rate and so on. Methods: The clinical symptoms, histology, virology and serum virus markers of 220 chronic hepatitis B virus carriers in Wuxi area were studied dynamically. Results: 220 cases of chronic hepatitis B virus carriers according to HBeAg-positive and anti-HBe positive group, two groups of inflammatory activity severity rank sum test, the difference was statistically significant (P <0.05), anti-HBe positive Group inflammation was more severe than HBeAg-positive group. The degree of fibrosis in group 2 was rank-sum test (P <0.05). The fibrosis in anti-HBe group was more severe than that in HBeAg-positive group. There were no significant differences in the severity of inflammatory activity (G0-1) (≥G2) between the two groups according to age group, <40 years old and ≥40 years old group (P> 0.05). There was significant difference between the two groups in the degree of fibrosis (S0-1) (≥S2) (P <0.01), and the fibrosis in the group of ≥40 years old was obviously heavier than that in the group <40 years old. In 5 years, 35 out of 220 cases showed reactivation of hepatitis B, accounting for 15.9% (35/220) of the total, in which hepatic pathology with obvious inflammation (≥G2) reactivation rate of hepatitis B was 27% (33 / 122). The reactivation rate was 2% (2/98) in the group of G0 ~ G1, the difference was statistically significant (P <0.01) Activation rate was significantly higher than those with low inflammation. Among 35 patients with hepatitis B reactivation, 27 (77.1%) were ≥40 years old, showing significant correlation between age and the rate of reactivation of hepatitis B virus carriers (P <0.01). The reactivation rate of ≥40 group was significantly higher Higher than <40-year-old group, but gender and reactivation rate was not related. 56 cases of secondary liver biopsy, 23 cases of 3 liver biopsy, the original (first liver biopsy) normal liver tissue within a few years is relatively stable, little change in pathology, the original pathological inflammation is not easy to recover, but can be Small fluctuations. Conclusion: The pathological changes of liver in 55% of patients with chronic hepatitis B virus have obvious abnormalities (inflammation≥G2). The reactivation rate of hepatitis B is closely related to the grading and age of liver inflammation.