乙型肝炎病毒对不同ALT状态下慢性乙型肝炎患者肝功和肝纤维化以及肝脏病理分期的影响
Effects of hepatitis B virus on liver function, liver fibrosis and liver pathological staging at different ALT stages

摘要：目的 探讨乙型肝炎病毒对不同免疫阶段慢性乙型肝炎患者肝功、肝纤维化以及肝脏病理分期的影响。方法 回顾性分析兰州大学第一医院确诊为慢性乙型肝炎的患者657例，采用全自动生化分析仪检测肝功能指标，采用全自动γ-放射免疫分析仪检测肝纤维化指标，采用全自动荧光定量PCR分析仪检测被测者的病毒载量，用方差分析比较在不同免疫阶段乙型肝炎病毒对慢性乙型肝炎患者肝功、肝纤维化的影响，用线性趋势卡方检验分析在不同免疫阶段乙型肝炎病毒对慢性乙型肝炎患者肝脏病理分期的影响。结果 在ALT正常组中，乙型肝炎病毒对肝功、肝纤维化的影响较弱，而在丙氨酸氨基转移酶(ALT)异常组中，乙型肝炎病毒对肝功、肝纤维化有明显影响，且以ALT≥正常上限2倍组中为甚。具体表现为随着病毒载量的增加，肝功能指标中ALT、天门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)、直接胆红素(DBiL)、间接胆红素(IBiL)增高，总蛋白(TP)、白蛋白(ALB)降低，肝纤维化指标中透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型胶原(PcⅢ) 、Ⅳ型胶原(CⅣ)均增高(P<0.05)。在ALT正常组中，乙型肝炎病毒的载量高低与肝脏病理分期无相关性联系，而在ALT异常组中，特别是ALT≥正常上限2倍组中乙型肝炎病毒的载量高低与肝脏病理分期有显著相关性联系。结论 乙型肝炎病毒在机体的不同免疫阶段对肝脏功能的影响是不同的，这为临床抗病毒治疗提供了循证医学证据。
ABSTRACT: Objective To evaluate the effects of hepatitis B virus on liver function, liver fibrosis, and liver pathological staging at different immune stages. Methods We made a retrospective analysis of 657 patients with chronic hepatitis B diagnosed in the First Hospital of Lanzhou University. Their liver function parameters, liver fibrosis parameters, and hepatitis B virus load were measured by automatic biochemical analyzer, automatic gamma-radiation immunity analyzer, and quantitative PCR analyzer, respectively. Effects of hepatitis B virus on liver function, liver fibrosis in different immune stages were analyzed by variance analysis. Effects of hepatitis B virus on liver pathological staging at different immune stages were analyzed by linear trend chi square test analysis. Results In ALT normal chronic hepatitis B patients group, viral load had mild effects on liver function and liver fibrosis parameters. However, in ALT abnormal chronic hepatitis B patients group, viral load had a significant effect on liver function and liver fibrosis parameters, and the effect was most obvious in ALT≥double upper limit of normal group. The specific manifestation was that with viral load increasing, liver function parameters including ALT, AST, TBiL, DBiL, and IBiL increased, while TP and ALB decreased. Liver fibrosis parameters HA, LN, PcⅢ, and CIV all increased (P<0.05). In ALT normal chronic hepatitis B patients group, viral load had no relationship with liver pathological staging. However, in ALT abnormal chronic hepatitis B patients group, especially ALT≥double upper limit of normal group, viral load was significantly related to liver pathological staging. Conclusion The effects of hepatitis B virus on patients’ liver function at different immune stages were different, thus providing evidence-based medicine support for clinical antiviral treatment