轻度慢性乙型肝炎患者肝脏细胞外基质和超微结构改变与临床相关性分析

摘要

目的 探讨轻度慢性乙型肝炎(CHB)患者细胞外基质和肝脏超微结构改变与临床的相关性.方法 选择慢性HBV感染者为研究对象,将其分为轻度CHB组(66例)和慢性HBV携带组(10例).对所有患者采集血清,并行肝穿刺活检,光镜和电镜下观察样本,将结果与血清生化学等指标进行对比分析.计量资料比较采用t检验,计数资料比较采用χ2检验,等级资料相关性使用非参数Spearman 分析.结果 轻度CHB组和慢性HBV携带组在ALT和AST两项指标上比较差异有统计学意义(t=12.42和7.06,P＜0.05),但HBV DNA水平差异无统计学意义(t=0.24,P＞0.05).两组患者血清肝纤维化指标(透明质酸、Ⅲ型胶原、Ⅳ型胶原和层黏连蛋白)差异均无统计学意义(t=0.45、0.95、0.76和1.21,P值均＞0.05).光镜组织学结果显示,轻度CHB组中,G2、S2以上的患者为33例,慢性HBV携带组为2例,两组差异有统计学意义(χ2=4.17,P＜0.05).轻度CHB组S3～4的患者(17例)明显多于慢性HBV携带组(0例,χ2=4.75,P＜0.05).电镜超微结构表现,狄氏间隙胶原纤维增生、汇管区扩大、贮脂细胞增生等反映肝脏纤维化相关的指标与光镜下纤维化分级相关系数分别为0.351、0.675和0.301(P值分别为0.004、0.000和0.014).结论 电镜下肝脏超微结构改变敏感性较光镜高,对轻度CHB患者的病情评估具有重要价值.%Objective To investigate the correlations of extracellular matrix and hepatic ultramicrostructural changes with clinical manifestations in patients with mild chronic hepatitis B (CHB).Methods Patients with chronic HBV infections were enrolled and were divided into mild CHB group (n=66) and HBV carrier group (n=10).Serum samples were collected from patients, and serum HBV markers, HBV DNA load and liver fibrosis indexes were measured.All subjects received liver biopsy, and the tissue samples were observed by light microscope and electron microscope.T test and χ2 test were performed for measurement data and enumeration data, respectively.Spearman test was used for ranked data.Results The differences on ALT and AST levels between mild CHB group and HBV carrier group were significant (t=12.42, 7.06, P＜0.05), but there was no significant difference on HBV DNA load between two groups (t=0.24, P ＞ 0.05).Serum liver fibrosis indexes (hyaluronic acid, type Ⅲ collagen,type Ⅳ collagen and laminin protein) in mild CHB group were not significantly higher than those in HBV carrier group (t=0.45, 0.95, 0.76 and 1.21, P ＞0.05).In mild CHB group, there were 33 patients with ≥G2 and ≥S2, but in HBV carrier group were only 2 patients (χ2=4.17, P ＜ 0.05).Seventeen patients in mild CHB group were with S3-4, while that was not observed in HBV carrier group (χ2=4.75, P ＜0.05).In mild CHB group, hepatic ultramicrostrutural changes on fat storing cell, collagen protein and portal area were correlated with fibrosis grades, and the correlation coefficients were 0.351, 0.675 and 0.301, respectively (P=0.004, 0.000 and 0.014).Conclusion Electron microscope is of higher sensitivity than light microscope in observing hepatic ultramicrostructural changes, which is effective in evaluating the severity of mild CHB.