HBeAg阴性高病毒载量谷丙转氨酶≤2倍正常值上限慢性HBV感染者伴明显肝脏组织学改变的独立预测因素

发布时间：2018-08-26 16:21

【摘要】：目的探索HBe Ag阴性高病毒载量谷丙转氨酶(alanine transaminase,ALT)≤2倍正常值上限(upper limit of normal,ULN)慢性HBV感染者伴明显肝脏组织学改变(significant liver histopathological changes,SLHC)的独立预测因素。方法回顾性分析113例初治HBe Ag阴性高病毒载量(HBV DNA≥104copies/ml)ALT≤2 ULN(ULN定义为50 IU/L)的慢性HBV感染者。采用T检验、Mann Whitney秩和检验和卡方检验比较各变量的组间差异。单因素和多因素分析筛查SLHC的独立预测因素。结果入组113例患者,其中43例(38.1%)伴SLHC,70例(61.9%)不伴SLHC。多因素分析发现HBV DNA(OR=1.560,P=0.032)和谷氨酰转肽酶(gamma-glutamyl transpeptidase,GGT)(OR=1.089,P=0.022)是HBe Ag阴性高病毒载量ALT≤2 ULN慢性HBV感染者伴SLHC的独立预测因素。4 log10 copies/ml≤HBV DNA≤6 log10 copies/ml组患者SLHC发生率明显低于HBV DNA6 log10 copies/ml组患者(32.3%vs 61.9%,P=0.003);GGT≤50 IU/L组患者SLHC发生率明显低于GGT50 IU/L组患者(33.3%vs 60%,P=0.024)。结论 HBe Ag阴性高病毒载量ALT≤2 ULN慢性HBV感染者中,HBV DNA6 log10 copies/ml或GGT50 IU/L的患者伴SLHC的可能性更大,更加迫切需要肝穿刺组织学评估。
[Abstract]:Objective To explore the independent predictors of significant hepatic histopathological changes (SLHC) in chronic HBV infected patients with HBe Ag negative high viral load (ALT) less than or equal to the upper limit of normal (ULN). Patients with chronic HBV infection whose viral load (HBV DNA < 104 copies / ml) was ALT < 2 ULN (ULN defined as 50 IU / L) were compared by T test, Mann Whitney rank sum test and chi-square test. Multivariate analysis showed that HBV DNA (OR = 1.560, P = 0.032) and gamma-glutamyl transpeptidase (GGT) (OR = 1.089, P = 0.022) were independent predictors of SLHC in HBe Ag-negative patients with high viral load ALT < 2 ULN chronic HBV infection. The incidence of SLHC in patients with GGT < 50 IU / L was significantly lower than that in patients with GGT 50 IU / L (33.3% vs 60%, P = 0.024). Conclusion HBe Ag negative high viral load ALT < 2 ULN chronic HBV infection, HBV DNA 6 log10 copies / ml or GGGT50 IU / L patients with SLHC were more likely to be associated with SLHC, and more urgently needed. Liver biopsy is needed for histological evaluation.
【作者单位】：复旦大学附属公共卫生临床中心肝炎一科;
【基金】：上海市科委“科技创新行动计划”医学与农业领域重点项目(13401902100) 上海市市级医院新兴前沿技术联合攻关项目(SHDC12015129)
【分类号】：R512.62;R575

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