Wang L, Fan Y X, Ding Y, Sheng Q J, Zhang C, Zhao L R, Xia T T, An Z Y, Bai H, Shi H Y, Dou X G
Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, China.
Zhonghua Gan Zang Bing Za Zhi. 2017 Jun 20;25(6):419-423. doi: 10.3760/cma.j.issn.1007-3418.2017.06.006.
To explore the difference of liver inflammation and fibrosis in patients with chronic hepatitis B virus (HBV) infection and chronic hepatitis C virus (HCV) infection, and to investigate the relationship between hepatic pathology and alanine aminotransferase (ALT). 57 patients with chronic HCV infection and 346 patients with chronic HBV infection who were hospitalized at Shengjing Hospital of China Medical University from January 2012 to September 2016 were enrolled. In chronic HBV infection, including 88 cases whose ALT were more than two times of upper limited of normal (ALT≥2×ULN) and 258 cases whose ALT were less than two times of upper limited of normal (ALT < 2×ULN).All the patients were underwent liver biopsy. Chronic HBV infection (ALT≥2×ULN and ALT < 2×ULN) and chronic HCV infection were compared respectively. Statistical analyses were performed using a Univariate ²-test and Mann-Whitney U test for comparison. Correlations between variables were analyzed using Spearman's rank correlation. In chronic HBV infection group, 169 cases (48.8%) had inflammation grade≥2 (G≥2), 98 cases (28.3%) had fibrosis stage≥2 (S≥2), 81 cases (23.4%) with G≥2 and S≥2.In the ALT < 2×ULN group, there were 109 cases (42.2%) with G≥2, 62 cases (24%) with S≥2, 49 cases (19%) with G≥2 and S≥2. In the ALT≥2×ULN group, 60 cases (68.2%) with G≥2, 35 cases (39.8%) with S≥2, 31 cases (35.2%) with G≥2 and S≥2. The grade of inflammation and fibrosis have significantly different between ALT≥2×ULN group and ALT < 2×ULN group (² = 17.66, ² = 8.06, < 0.01). In chronic HCV infection group, 47 cases (82.5%) with G≥2, 20 cases (35.1%) with S≥2, 20 cases (35.1%) with G≥2 and S≥2. ALT had no correlation with inflammation and fibrosis ( > 0.05). The grade of inflammation was significantly different between chronic HCV infection and chronic HBV infection whose ALT < 2×ULN (² = 30.19, < 0.01) but the fibrosis have no difference (² = 2.96, > 0.05). Compared with chronic HBV infection whose ALT≥2×ULN, both inflammation and fibrosis had no significantly different (² = 3.65, ² = 0.32, > 0.05 respectively). In chronic HBV infection whose ALT < 2×ULN, about 30%-40% liver tissue with significant necroinflammation and /or fibrosis. About 80% chronic HCV infection with significant necroinflammation, and the grade of inflammation has no correlation with ALT. The grade of inflammation has significantly different between chronic HCV infection group and chronic HBV infection group whose ALT < 2×ULN.
为探讨慢性乙型肝炎病毒（HBV）感染与慢性丙型肝炎病毒（HCV）感染患者肝脏炎症和纤维化的差异，并研究肝脏病理学与丙氨酸氨基转移酶（ALT）之间的关系。纳入2012年1月至2016年9月在中国医科大学附属盛京医院住院的57例慢性HCV感染患者和346例慢性HBV感染患者。在慢性HBV感染患者中，包括88例ALT高于正常上限两倍（ALT≥2×ULN）的患者和258例ALT低于正常上限两倍（ALT < 2×ULN）的患者。所有患者均接受肝脏活检。分别比较慢性HBV感染（ALT≥2×ULN和ALT < 2×ULN）与慢性HCV感染。采用单因素²检验和Mann-Whitney U检验进行统计学分析以作比较。使用Spearman等级相关性分析变量之间的相关性。在慢性HBV感染组中，169例（48.8%）炎症分级≥2（G≥2），98例（28.3%）纤维化分期≥2（S≥2），81例（23.4%）G≥2且S≥2。在ALT < 2×ULN组中，109例（42.2%）G≥2，62例（24%）S≥2，49例（19%）G≥2且S≥2。在ALT≥2×ULN组中，60例（68.2%）G≥2，35例（39.8%）S≥2，31例（35.2%）G≥2且S≥2。ALT≥2×ULN组与ALT < 2×ULN组之间的炎症分级和纤维化分期有显著差异（² = 17.66，² = 8.06，P < 0.01）。在慢性HCV感染组中，47例（82.5%）G≥2，20例（35.1%）S≥2，20例（35.1%）G≥2且S≥2。ALT与炎症和纤维化无相关性（P > 0.05）。ALT < 2×ULN的慢性HCV感染与慢性HBV感染之间炎症分级有显著差异（² = 30.19，P < 0.01），但纤维化无差异（² = 2.96，P > 0.05）。与ALT≥2×ULN的慢性HBV感染相比，炎症和纤维化均无显著差异（² = 3.65，² = 0.32，P均> 0.05）。在ALT < 2×ULN的慢性HBV感染中，约30%-40%的肝组织有显著坏死性炎症和/或纤维化。约80%的慢性HCV感染有显著坏死性炎症，且炎症分级与ALT无相关性。ALT < 2×ULN的慢性HCV感染组与慢性HBV感染组之间炎症分级有显著差异。
