不同基因类型HBV感染早期肝硬化患者肝脏病理与临床的关系

Hepatic pathological and clinical relationship in early cirrhosis patients infected with different HBV genotypes

摘要:

目的：探讨慢性乙型肝炎（chronic hepatitis B，CHB）患者中早期肝硬化与非肝硬化患者在HBV基因型及临床常用的各项非创伤性指标方面的差异。方法：随机选择CHB患者178例进行肝穿刺活检病理检查，进行分级分期诊断，将其分为非肝硬化组（S0～S3期）及早期肝硬化组（S4期）；采用实时荧光定量PCR方法对其中90例患者行HBV基因分型。结果：178例CHB患者非肝硬化组134例，占75.3%；肝硬化组44例，占24.7%。２组在性别、年龄及HBeAg的表达上有差异（表１）；肝硬化组中C基因型所占的比例（55.6%）明显高于非肝硬化组（22.2%），差异有统计学意义（?字2=7.788，P=0.005）；HBV DNA在肝硬化及非肝硬化组中的数值变化无统计学意义；２组在总胆红素、碱性磷酸酶、γ-谷氨酸转肽酶、谷草转氨酶、白蛋白、球蛋白、前白蛋白、胆碱酯酶、血小板、脾脏肋间厚度上的差异有统计学意义（表４）。结论：临床诊断为CHB的患者中，通过肝活检发现24.7%存在有早期肝硬化，提示仅依据临床资料可能使近1/4的CHB患者病情被低估。C基因型CHB患者肝组织病理改变明显重于B基因型，B、C基因型分型检测结合肝穿刺病理检查有助于判断疾病轻重及预后，有助于指导治疗及评估预后。

Abstract:

Objective：To discuss differences in HBV genotypes and nontraumatic indexes commonly used in clinics between chron－ic hepatitis B（CHB） patients with early cirrhosis and CHB patients without cirrhosis. Methods：Totally 178 patients with CHB were selected randomly for liver biopsy pathological examination and underwent hierarchical diagnosis. All patients were divided into non cirrhosis group（S0-S3 stage） and early cirrhosis group（S4 stage）. Real-time fluorescence quantitative polymerase chain reaction（PCR） was used to do HBV genotype. Results：There were 134 cases in non cirrhosis group，accounting for 75.3%；44 cases in cirrhosis group，accounting for 24.7%. There were differences in gender，age and HBeAg expression between two groups. Proportion of C geno－type was much higher in cirrhosis group（55.6%） than in non cirrhosis group（22.2%），with statistical differences. There was no statis－tical difference in numerical change of HBV DNA between cirrhosis group and non cirrhosis group. There were statistical differences in total bilirubin，alkaline phosphatase，gamma-glutamyltranspeptidase，aspertate aminotransferase，albumin，globulin，prealbumin，cholinesterase，platelet，spleen intercostal thickness between two groups. Conclusions：Among all clinically diagnosed CHB patients，24.7% have early cirrhosis based on the results of liver biopsy，indicating 1/4 patients’ condition may be underestimated. Pathological changes of liver tissue are significantly heavier in CHB patients with C genotype than those with B genotype. B，C genotype classifi－cation combined with liver biopsy helps to determine the severity and prognosis of disease，conducive to the treatment and assessment.