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目的本研究以血清e抗原状况和患者年龄分组对ALT<2×ULN的乙型肝炎(CHB)患者血清HBV DNA水平与肝脏炎症和纤维化严重程度的相关性进行探讨。方法对253例ALT<2×ULN的CHB患者进行肝组织病理学检查,并检测肝功能、HBV DNA定量和HBV血清标志物,分别按肝脏病理分级、e-抗原状态和HBV DNA载量分组,比较各组肝脏炎症及纤维化程度。结果重度肝脏炎症、纤维化组中HBeAg阴性比例均较轻度组高(P=0.043,P=0.033);重度肝脏炎症、纤维化组患者年龄均较轻度组大(P=0.004,P=0.000)。HBeAg阴性患者中高病毒载量组中肝脏炎症、纤维化患者比例较高(P=0.001,P=0.007)。≥38岁的HBeAg阴性CHB患者中,高病毒载量组较低病毒载量的患者重度肝脏炎症及纤维化比例高(P=0.000,P=0.041),HBeAg阳性CHB患者中,低病毒载量CHB患者比高病毒载量的患者重度肝脏炎症及纤维化比例高(P=0.042,P=0.042),年龄<38岁的CHB患者无论是HBeAg阳性和阴性CHB患者肝脏炎症及纤维化严重程度与血清HBV DNA水平间均无相关。结论年龄是预测不同HBV DNA水平下CHB患者结局的关键因素。对于ALT<2×ULN的CHB患者,均应积极建议患者进行肝脏穿刺活组织检查,而对于≥38岁HBeAg阳性低病毒载量的CHB患者更应给予高度重视。
Objective To investigate the relationship between serum HBV DNA levels and severity of hepatic inflammation and fibrosis in patients with ALT <2 × ULN and with hepatitis B (CHB) patients by grouping serum e antigen status and patient age. Methods A total of 253 CHB patients with ALT <2 × ULN were enrolled in this study. Liver function, HBV DNA quantitation and serum HBV markers were detected by histopathological grade, e-antigen status and HBV DNA load respectively. Liver inflammation and fibrosis were compared between groups. Results Severe hepatic inflammation and fibrosis were more frequent in HBeAg-negative patients than in mild patients (P = 0.043, P = 0.033). Severe hepatic inflammation and fibrosis patients were older than mild patients (P = 0.004, P = 0.000). Among HBeAg-negative patients, the proportion of patients with liver inflammation and fibrosis in the high viral load group was higher (P = 0.001, P = 0.007). Among patients with HBeAg-negative CHB who were ≥38 years old, the patients with high viral load had lower rates of severe liver inflammation and fibrosis (P = 0.000, P = 0.041). In patients with HBeAg-positive CHB, patients with low viral load Patients with CHB had a higher rate of severe liver inflammation and fibrosis than those with high viral load (P = 0.042, P = 0.042). CHB patients <38 years of age had both liver inflammation and fibrosis severity in patients with HBeAg-positive and -negative CHB Serum HBV DNA levels were not related. Conclusion Age is a key factor in predicting the outcome of patients with CHB at different HBV DNA levels. For CHB patients with ALT <2 × ULN, patients should be actively recommended for biopsy of the liver and more attention should be given to CHB patients ≥38 years of age with low HBeAg-positive viral load.