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目的研究慢性HBV感染者自然史各期中肝组织纤维化演变规律。方法按照《慢性乙型肝炎防治指南(2010年版)》描述的CHB自然史分期的血清学特征作为纳入标准,将慢性HBV感染者分为免疫耐受期、免疫清除期、非活动或低(非)复制期以及再活动期,统计和分析各组患者的性别、年龄、ALT水平、血清HBV DNA、肝组织炎症(G)的变化特点,以及各组肝组织纤维化(S)的演变规律。结果共637例患者,其中男性501例(78.6%),女性136例(21.4%)。免疫耐受期患者101例,免疫清除期患者248例,低(非)复制期患者119例,再活动期患者169例。各期患者的相应肝组织炎症分级比较均有统计学意义,其中免疫清除期和再活动期肝组织炎症较为活跃(χ2=150.424,P<0.0001)。各期患者肝纤维化分期亦有统计学差异,其纤维化程度呈渐次加重的趋势(χ2=141.682,P<0.0001)。结论慢性HBV感染者自然史表现为肝组织炎症反复活跃、肝组织纤维化程度进行性加重的过程。
Objective To study the evolution of hepatic fibrosis in patients with chronic HBV infection during the natural history. Methods According to the serological characteristics of natural history staging of CHB described in Guideline for Prevention and Treatment of Chronic Hepatitis B (2010 Edition), chronic HBV infection was divided into immune tolerance period, immune clearance period, inactivity or low ), Reproductive phase and reactivation phase. The changes of gender, age, ALT level, serum HBV DNA and inflammation of liver tissue (G) in each group were statistically analyzed. The changes of hepatic fibrosis (S) in each group were also analyzed. Results A total of 637 patients, including 501 males (78.6%) and 136 females (21.4%). There were 101 cases of immune tolerance, 248 cases of immune clearance, 119 cases of low (non) replication stage and 169 cases of re-active stage. The corresponding grade of liver inflammation in all patients were statistically significant, of which immune inflammation and reactivation of liver inflammation more active (χ2 = 150.424, P <0.0001). The stages of liver fibrosis in all patients were also statistically different, the degree of fibrosis was gradually increased (χ2 = 141.682, P <0.0001). Conclusion The natural history of patients with chronic HBV infection is characterized by the active inflammation of liver tissue and the progressive aggravation of hepatic fibrosis.