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目的探讨HBeAg阳性与HBeAg阴性慢性乙型肝炎(CHB)患者的临床和肝组织病理损伤特点。方法经肝活检病理诊断为CHB患者548例,分为HBeAg阳性与HBeAg阴性2组,分别统计患者年龄、肝组织炎症活动度(G分级)、纤维化程度(S分期)、肝活检前后2周肝功能(ALB、GLB、TBil、ALT、AST、GGT)峰值、血清HBVDNA载量、肝组织病理改变与临床之间的关系。结果肝组织G分级、S分期与肝功能改变有相关性(P均<0.01),肝功能明显异常者肝组织病理损伤亦重;S分期与G分级有相关性(P<0.01),S分期随G分级升高而加重。HBeAg阳性者较HBeAg阴性者平均年龄小,ALT、AST水平及HBVDNA载量高(P均<0.01)。HBeAg阴性者肝组织G分级、S分期与患者年龄有相关性(P均<0.05),与HBVDNA载量有显著相关性(P均<0.01);而HBeAg阳性者G分级、S分期与患者年龄、HBVDNA载量无相关性(P均>0.05)。结论CHB肝功能改变可以反映肝脏病理损害程度,S分期随G分级升高而加重。HBeAg阳性与HBeAg阴性CHB患者临床表现有所不同:HBeAg阴性CHB患者年龄较大,ALT、AST水平及HBVDNA载量较低。除肝功能改变外,患者年龄、血清HBVDNA载量可作为HBeAg阴性CHB患者肝脏病变程度的预测指标。
Objective To investigate the clinical and hepatic pathological features of patients with HBeAg-positive and HBeAg-negative chronic hepatitis B (CHB). Methods 548 CHB patients diagnosed by liver biopsy were divided into two groups: HBeAg-positive and HBeAg-negative. The patients’ age, degree of liver inflammation (G grade), degree of fibrosis (S stage) The peak of liver function (ALB, GLB, TBil, ALT, AST, GGT), the serum HBVDNA load, the relationship between the pathological changes of liver tissue and clinic. Results There was a significant correlation between G stage, S stage and liver function (all P <0.01), and pathological changes of liver in patients with obvious abnormal liver function. S stage was correlated with G stage (P <0.01) With the grading of G increased. The average age of HBeAg-positive patients was lower than that of HBeAg-negative patients, while the levels of ALT, AST and HBVDNA were higher (all P <0.01). There was a significant correlation between G grade, S stage and patient’s age (all P <0.05) and HBVDNA load (all P <0.01), while HBeAg positive patients’ G stage, S stage and patient’s age , No correlation between HBVDNA load (P> 0.05). Conclusions The changes of liver function in CHB can reflect the degree of hepatic pathological damage, and the S stage aggravates with the increase of G grade. HBeAg-positive and HBeAg-negative patients with CHB clinical manifestations vary: HBeAg-negative CHB patients older, ALT, AST levels and HBVDNA load is low. In addition to changes in liver function, patient age, serum HBVDNA load can be used as a predictor of liver lesions in patients with HBeAg-negative CHB.