HBeAg阳性和阴性慢性乙型肝炎患者肝组织学与血清学关系的比较

摘要

Objective To investigate the potential relationship between histopathological features and hepatitis B e antigen (HBeAg) serological status in chronic hepatitis B ( CHB) patients with 1 x upper limit normal ( ULN) ≤ alanine aminotransferase (ALT) ≤2 × ULN. Methods A total of 516 CHB patients with 1 × ULN ≤ALT ≤2 ×ULN were enrolled for study prior to any therapeutic intervention. Serum samples were used for analysis of hepatitis B virus ( HBV) DNA, HBeAg and hepatitis B surface antigen ( HBsAg) expression ( +/ - ) , hyaluronic acid ( HA) , and α2 - macroglobulin ( α2m). Liver biopsies were used for pathological analysis of inflammation ( G0 -4) and fi-brosis ( S0 -4). Results In HBeAg( + ) patients, levels of HBsAg and HBeAg were each negatively correlated with pathological severity, while HA and α2m levels were both positively correlated with liver pathological severity. In HBeAg( - ) patients, HBV DNA level was positively correlated with liver pathological severity. Conclusion Serum HBV DNA can be used as a predictive marker of liver disease in HBeAg( - ) CHB patients. HBsAg, HBeAg, HA, and α2m can be used as predictive markers of liver injury in HBeAg( + ) CHB patients.%目的 研究慢性乙型肝炎(CHB)患者(1×ULN≤ALT≤2×ULN)肝组织学与血清学的关系.方法 对全国多中心516例CHB患者(1×ULN≤ALT≤2×ULN)行血清学及肝穿刺病理检查,依据血清HBeAg表达水平将患者分为HBeAg阳性组和HBeAg阴性组,分析两组肝组织病理学与血清学指标的相关性.结果 HBeAg阳性患者肝组织炎症分级和肝纤维化分期与血清HBsAg和HBeAg表达水平呈负相关(P＜0.01),与血清透明质酸(HA)和α2-巨球蛋白水平呈正相关(P＜0.01),与血清HBVDNA水平无明显相关性;HBeAg阴性患者肝组织炎症分级和肝纤维化分期与血清HBV DNA水平呈正相关(P＜0.01),与HBsAg、HA和α2-巨球蛋白等无明显相关性.结论 血清HBV DNA可做为HBeAg阴性CHB患者肝脏病变程度的有效预测指标,HBsAg、HBeAg、HA和α2-巨球蛋白均可做为HBeAg阳性CHB患者肝组织损伤的预测指标.