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目的探讨慢性乙型肝炎(chronic hepatitis B,CHB)患者肝纤维化进展与丙氨酸氨基转移酶(ALT)演变规律的相关性。方法选取深圳市第三人民医院2000年1月至2011年1月住院并行肝脏组织活检的510例慢性乙型肝炎患者,经肝组织活检术明确其纤维化程度,根据纤维化的进展分为两个阶段,早中期阶段(S0→S1→S2)与中后期阶段(S2→S3→S4),两阶段均按ALT分成A[ALT≤正常值上限(ULN,ULN=40 U/L)]、B(ULN2×ULN)3组。探讨两个阶段纤维化进展与ALT各组之间的相关性。结果 510例患者中,男性391例(76.67%),女性119例(23.33%),纤维化早中期患者404例(S0期28例,S1期261例,S2期115例),随着纤维化进展(S0→S1→S2),纤维化与ALT之间的差异有统计学意义(χ~2=25.377,P=0.00)。三组ALT经过χ~2分割法(即Bonferroni法)比较,检验水准调整为0.05/3(即0.017),各组之间的ALT水平差异均有统计学意义(P值均<0.017)。经Spearman等级相关分析r=0.137,即随着纤维化进展,血清ALT呈逐渐上升趋势。纤维化中后期患者221例(S2期115例,S3期67例,S4期39例),随着肝纤维化进展(S2→S3→S4),纤维化与ALT之间的差异无统计学意义(χ~2=6.365,P=0.173)。三组ALT经过χ~2分割法比较,检验水准调整为0.05/3(即0.017),各组之间的ALT水平差异亦无统计学意义(P值均>0.017)。结论在CHB肝纤维化进展过程中,肝纤维化早中期阶段对应的ALT呈现逐渐升高的趋势,而中后期阶段与ALT无相关性。
Objective To investigate the relationship between the progression of hepatic fibrosis and the evolution of alanine aminotransferase (ALT) in patients with chronic hepatitis B (CHB). Methods A total of 510 patients with chronic hepatitis B who underwent in-hospital liver biopsy from January 2000 to January 2011 in Shenzhen Third People’s Hospital were enrolled. The degree of fibrosis was confirmed by biopsy of liver tissue, and was divided into two according to the progress of fibrosis (S0 → S1 → S2) and the middle and late stage (S2 → S3 → S4), and the two stages are divided into A [ALT≤maximum limit of normal (ULN, ULN = 40 U / L)] according to ALT, B (ULN 2 × ULN). To investigate the correlation between the two stages of fibrosis progression and ALT groups. Results Among the 510 patients, 391 (76.67%) were male, 119 (23.33%) were female, 404 were early-stage fibrosis (28 in stage S0, 261 in stage S1, and 115 in stage S2) The progress (S0 → S1 → S2), fibrosis and ALT was statistically significant (χ ~ 2 = 25.377, P = 0.00). The ALT levels of three groups were compared by χ ~ 2 method (Bonferroni method), and the level of ALT was adjusted to 0.05 / 3 (0.017). The differences of ALT between the three groups were statistically significant (P <0.017). Spearman rank correlation analysis r = 0.137, that is, with the progress of fibrosis, serum ALT showed a gradual upward trend. There were 221 patients with mid-and-late fibrosis (115 cases in stage S2, 67 cases in stage S3 and 39 cases in stage S4). There was no significant difference between fibrosis and ALT with the progression of liver fibrosis (S2 → S3 → S4) (χ ~ 2 = 6.365, P = 0.173). There was no significant difference in the ALT levels between the three groups (all P> 0.017) after the chi-square test was adjusted to 0.05 / 3 (0.017). Conclusions During the progression of liver fibrosis in CHB, the corresponding ALT in the early and middle stages of liver fibrosis shows a gradual upward trend, but there is no correlation with ALT in the late stage of liver fibrosis.