Gui Hong-Lian, Xie Qing, Wang Hui, Cai Wei, Lin Zhi-Mei, Jiang Shan, Xu Pei, Zhou Xia-Qiu, Guo Qing, Yu Hong
Department of Infectious Diseases, Affiliated Ruijin Hospital to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Zhonghua Gan Zang Bing Za Zhi. 2007 Dec;15(12):881-5.
To study the histological changes in livers of chronic hepatitis B (CHB) patients with persistently normal serum ALT levels (PNAL).
274 CHB patients who had percutaneous liver biopsies and had a detectable viral load (lower limit of detection is 10(3) copies/ml) in our department between October 2003 and February 2007 were included in this study. Among these patients, 139 had PNAL, group A, (with at least 3 normal serum ALT levels, with intervals of more than two months over a period of 12 or more months before the biopsy). The other 135 patients, group B, had abnormal serum ALT levels during the same period. The histological changes in the livers of the two groups of patients were compared.
Sixty-six (47.5%) patients with PNAL had normal liver histology, but significant pathohistological changes such as significant necroinflammation, fibrosis and/or cirrhosis were found in 33 (23.7%) patients. Thirteen (9.4%) had established cirrhosis. When compared to patients within (0-0.75)x upper limit of normal (ULN) ALT, patients within (0.76-1.00)x ULN ALT had higher scores of histological changes (43.5% vs. 19.8%, P < 0.05). In the PNAL group, scores of histological changes increased sharply in parallel with an age increase of older than 40 yrs. However neither viral loads nor HBeAg statuses of the PNAL patients had any predictive meaning to the scores of the histological findings.
23.7% of our CHB patients with PNAL, regardless of what their HBeAg statuses or viral load levels were, had significant liver pathohistological changes. Liver biopsies should be considered in CHB patients with PNAL, especially those older than 40 yrs and with a higher ALT within (0.76-1) x ULN.
研究血清谷丙转氨酶（ALT）水平持续正常的慢性乙型肝炎（CHB）患者肝脏的组织学变化。
纳入2003年10月至2007年2月在我科接受经皮肝穿刺活检且病毒载量可检测到（检测下限为10³拷贝/毫升）的274例CHB患者。其中，139例为血清ALT水平持续正常组（A组）（在活检前12个月或更长时间内至少有3次血清ALT水平正常，间隔超过2个月）。另外135例患者为同期血清ALT水平异常组（B组）。比较两组患者肝脏的组织学变化。
139例血清ALT水平持续正常的患者中，66例（47.5%）肝脏组织学正常，但33例（23.7%）患者存在明显的病理组织学变化，如显著坏死性炎症、纤维化和/或肝硬化。13例（9.4%）已发展为肝硬化。与ALT在（0 - 0.75）×正常上限（ULN）范围内的患者相比，ALT在（0.76 - ）×ULN范围内的患者组织学变化评分更高（43.5%对19.8%，P < 0.05）。在血清ALT水平持续正常组中，年龄大于40岁时，组织学变化评分随年龄增长急剧增加。然而，血清ALT水平持续正常患者的病毒载量和HBeAg状态对组织学结果评分均无预测意义。
在我们的血清ALT水平持续正常的CHB患者中，23.7%的患者无论其HBeAg状态或病毒载量水平如何，均存在明显的肝脏病理组织学变化。对于血清ALT水平持续正常的CHB患者，尤其是年龄大于40岁且ALT在（0.76 - 1）×ULN范围内较高的患者，应考虑进行肝活检。
