124例儿童慢性乙型肝炎肝组织病理变化特征分析

摘要

Objective To investigate the liver histological characteristics of children with chronic hepatitis B (CHB).Methods We recruited data of children with CHB and liver biopsy,then analyzed their liver histopathological characteristics and their associations with laboratory parameters.Results One hundred and twenty-four children with CHB were included in the present study,including 114 (91.9％) HBeAg-positive CHB children and 10 (8.1％) HBeAg-negative CHB children.In HBeAg-positive CHB children,the frequency of significant necroinflammation stratified by ALT levels was 32.1％ (9/28) in ALT ≤ULN,60.7％ (17/28) in ALT(1-2) ×ULN and 81.0％ (47/58) in ALT＞2 ×ULN group,while significant fibrosis was 46.4％ (13/28) in ALT ≤ ULN,71.4％ (20/28) in ALT (1-2) × ULN and 74.1％ (43/58) in ALT ＞ 2 × ULN group,respectively.Significant liver histological abnormalities were much higher in the ALT ＞ 2 × ULN and ALT (1-2) × ULN groups than the ALT ≤ ULN group.Logistic analysis indicated only AST levels associated with significant inflammation (OR =1.032,P =0.008) and significant fibrosis (OR =1.026,P =0.007).Conclusion Frequencies of significant liver histological abnormalities in children with CHB are high,and AST levels are associated with them.%目的 探讨儿童慢性乙型肝炎(CHB)患者肝组织病理变化特征.方法 回顾性收集伴有肝活检儿童CHB患者资料,分析其肝组织病理变化特征及其实验室预测指标.结果 共124例儿童CHB纳入本项研究,其中HBeAg阳性114例(91.9％)、HBeAg阴性10例(8.1％).HBeAg阳性儿童CHB组中,不同ALT水平显著性肝脏炎症发生率ALT≤正常值上限(ULN)组32.1％ (9/28)、ALT(1 ～2)×ULN组60.7％ (17/28)与ALT＞2×ULN组81.0％ (47/58),显著性肝纤维化发生率为ALT≤ULN组46.4％(13/28)、ALT (1～2) ×ULN组71.4％ (20/28)与ALT＞2×ULN组74.1％ (43/58).ALT(1 ～2)×ULN组与ALT＞2 × ULN组的显著性肝组织异常发生率较ALT≤ULN组明显升高.Logistic回归分析显示仅AST水平与显著性肝脏炎症(OR=1.032,P=0.008)与显著性肝纤维化(OR=1.026,P=0.007)相关.结论 儿童CHB中显著性肝脏组织学异常发生率较高,AST水平可反映病理变化程度.