乙型肝炎肝硬化患者肝脏病变的相关因素研究

Related factors of liver lesion in patients with hepatitis B associated cirrhosis

摘要:

目的  探讨乙型肝炎肝硬化患者肝脏组织炎症活动度（G）的影响因素。方法  选取2011年8月-2014年10月于四川省人民医院住院治疗的112例乙型肝炎肝硬化患者进行肝脏组织病理学检查、血生物化学检测及HBV-DNA定量检测。根据肝脏组织病理学检查结果将患者分为G0-G1组、G2组和G3-G4组，比较不同肝脏炎症活动度患者间各临床指标的差异。采用Spearman相关分析和Logstic多元回归分析与肝脏组织炎症活动度相关的因素。结果  112例乙型肝炎肝硬化患者中87例仅有轻度活动性炎症（G0-G1、G2），占77.68%。G0-G1组、G2组及G3-G4组3组患者间年龄、血小板计数（PLT）、凝血酶原时间（PT）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转移酶（γ-GT）、AST-PLT比值 （APRI）、前白蛋白（PA）、胆碱酯酶（ChE）、胆汁酸（TBA）等指标差异有统计学意义（P <0.05）。Spearman相关分析结果显示，肝脏炎症活动度与年龄、PT、AST、γ-GT、APRI、TBA呈正相关（P <0.05）；与PLT、PA及ChE呈负相关（P <0.05）。Logistic多因素分析结果显示，年龄、PT、AST、γ-GT、PA及ChE是影响肝硬化患者肝脏组织发生明显炎症反应的主要影响因素。  结论  年龄大、血清PT、AST及γ-GT水平升高、PA及ChE水平降低是乙型肝炎肝硬化患者肝脏组织发生显著炎症改变的危险因素。

Abstract:

Objective To investigate the related factors of liver inflammation activity (G) in patients with hepatitis B associated cirrhosis. Methods 112 patients with hepatitis B associated cirrhosis underwent liver biopsy, blood biochemistry detection and quantitative detection of HBV-DNA from August 2011 to October 2014 were selected for this study. According to the results of liver histopathology, patients were divided into G0~G1 group, G2 group and G3~G4 group, and the various clinical indicators among the three groups were compared. The Spearman correlation analysis and multiple regression analysis Logstic were used to analysis the related factors to liver inflammation activity related. Results In 112 cases, 87 cirrhosis patients were only with mild active inflammation (G0~G1, G2), the rate was 77.68 %. Age, platelet count (PLT), prothrombin time (PT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ - glutamyl transferase (γ-GT), AST-PLT ratio (APRI), prealbumin (PA), cholinesterase (ChE) and index difference bile acid (TBA) among G0~G1 group, G2 group and G3~G4 group were statistically different (P < 0.05). Spearman correlation analysis showed that liver inflammatory activity was positively correlated with age, PT, AST, γ-GT, APRI and TBA (P < 0.05); and negatively correlated with PLT, PA and ChE (P < 0.05). Logistic multivariate analysis showed that age, PT, AST, γ-GT, PA and ChE were the main factors affecting liver inflammatory activity. Conclusions older age, higher serum levels of PT, AST and γ-GT, lower levels of PA and ChE are risk factors liver inflammatory activity in patients with hepatitis B associated cirrhosis.