慢性乙型肝炎与慢性丙型肝炎患者临床和肝组织病理学特征分析
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摘要
目的分析慢性乙型肝炎(CHB)与慢性丙型肝炎(CHC)患者临床特征及肝组织病理学表现的差异。方法 2013年～2017年我院诊治的CHB患者300例和CHC患者100例,收集临床资料并行肝活检组织病理学检查。结果本组资料显示,CHC患者年龄显著大于【(47.6±12.8)岁对(36.3±9.7)岁】、病程显著长于【(13.1±0.9)年对(6.2±1.8)年】、基础疾病显著多于(39.0%对18.7%)、经血感染显著多于(63.0%对36.7%)、母婴传播显著少于(3.0%对29.7%)、吸毒感染显著多于(40.0%对7.0%)和性传播显著少于(14.0%对26.7%)CHB患者(P<0.05);CHB患者血清ALT水平为(76.5±10.8) U/L,AST水平为(111.2±21.3) U/L,与CHC患者的【(105.2±20.8) U/L和(98.3±20.1) U/L】比,差异显著(P<0.05);CHC患者肝组织炎症分级>G2者为83.0%,显著高于CHB患者的48.7%(P<0.05),而肝纤维化分期>S2者为65.0%,也显著高于CHB患者的28.3%(P<0.05)。结论CHC患者由于病程长,发病隐匿,肝组织损伤更明显,需要积极的治疗。
Objective To compare the clinical and histopathological features in patients with chronic hepatitis B(CHB) and chronic hepatitis C(CHC). Methods The clinical data of 300 patients with CHB and 100 patients with CHC in our hospital between 2013 and 2017 were collected and analyzed retrospectively. The liver biopsies were performed in all the cases. Results The materials in our series indicated that the age was older 【(47.6±12.8)yr vs.(36.3±9.7)yr】,the illness period was longer 【(13.1±0.9)yr vs.(6.2±1.8)yr】,underlying disease was more multiple(39.0% vs. 18.7%),blood-borne infection was more common(63.0% vs. 36.7%),mother-to-infant vertical transmission was more less(3.0% vs. 29.7%),intravenous infection was more common(40.0% vs. 7.0%)and sexual transmitted infection was more less(14.0% vs. 26.7%) than in patients with CHB(P<0.05);serum ALT level was(76.5±10.8) U/L and serum AST level was(111.2±21.3) U/L in patients with CHB,significantly different as compared to 【(105.2 ±20.8) U/L and(98.3 ±20.1) U/L】 in patients with CHC(P <0.05);the hepatic histopathological examination showed that >G2 hepatic activity(HAI) index in patients with CHC was 83.0%,much higher than 48.7%(P<0.05) in patients with CHB,and >S2 liver fibrosis was 65.0%,also significantly higher than 28.3%(P<0.05) in patients with CHB. Conclusion There are many clinical and histopathological differences between patients with CHC and with CHB,and severe liver injuries and fibrosis might be more common in patients with CHC due to longer infection periods,which needs more medical interventions.
Objective To compare the clinical and histopathological features in patients with chronic hepatitis B(CHB) and chronic hepatitis C(CHC). Methods The clinical data of 300 patients with CHB and 100 patients with CHC in our hospital between 2013 and 2017 were collected and analyzed retrospectively. The liver biopsies were performed in all the cases. Results The materials in our series indicated that the age was older 【(47.6±12.8)yr vs.(36.3±9.7)yr】,the illness period was longer 【(13.1±0.9)yr vs.(6.2±1.8)yr】,underlying disease was more multiple(39.0% vs. 18.7%),blood-borne infection was more common(63.0% vs. 36.7%),mother-to-infant vertical transmission was more less(3.0% vs. 29.7%),intravenous infection was more common(40.0% vs. 7.0%)and sexual transmitted infection was more less(14.0% vs. 26.7%) than in patients with CHB(P<0.05);serum ALT level was(76.5±10.8) U/L and serum AST level was(111.2±21.3) U/L in patients with CHB,significantly different as compared to 【(105.2 ±20.8) U/L and(98.3 ±20.1) U/L】 in patients with CHC(P <0.05);the hepatic histopathological examination showed that >G2 hepatic activity(HAI) index in patients with CHC was 83.0%,much higher than 48.7%(P<0.05) in patients with CHB,and >S2 liver fibrosis was 65.0%,also significantly higher than 28.3%(P<0.05) in patients with CHB. Conclusion There are many clinical and histopathological differences between patients with CHC and with CHB,and severe liver injuries and fibrosis might be more common in patients with CHC due to longer infection periods,which needs more medical interventions.
引文
[1]侯春艳,杨永峰.CHB抗病毒治疗新进展.实用肝脏病杂志,2017,20(1):124-128.
[2]封波,尚佳,武淑环,等.Y型聚乙二醇干扰素α-2b注射液治疗HCV基因2/3型CHC患者疗效和安全性的多中心随机对照试验研究.实用肝脏病杂志,2017,20(3):284-289.
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[4]DuskováD,Darebnícek L.Nucleic acid testing of hepatitis Bvirus,hepatitis C virus,and human immunodeficiency virus1,2 in blood donors in the General University Hospital,Prague.Acta Virologica,2014,58(2):146-151.
[5]Gong XQ,Yang JE,Tang JM,et al.A Mechanistic Assessment of the Discordance between Normal Serum Alanine Aminotransferase Levels and Altered Liver Histology in Chronic Hepatitis B.PLoS One,2015,10(7):e0134532.
[6]王琳,樊耀昕,丁洋,等.乙型肝炎病毒和丙型肝炎病毒慢性感染者肝组织病理学炎症及纤维化对比分析.中华肝脏病杂志,2017,5(6):419-423.
[7]中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版).实用肝脏病杂志,2016,19(3):Ⅴ-ⅩⅩⅢ.
[8]陈红松,窦晓光,段钟平,等.丙型肝炎防治指南(2015年更新版).实用肝脏病杂志,2015,29(12):1961-1979.
[9]谢琴秀,徐楠,江晓平,等.FibroScan对CHB病毒感染者肝纤维化评估的影响因素分析.中华肝脏病杂志,2016,24(9):659-664.
[10]Zuure F,Bil J,Visser M,et al.Prevalence of hepatitis B virus and hepatitis C virus infection among six ethnic groups living in Amsterdam,the Netherlands-The HELIUS study.JHepatol,2017,66(1):S405.
[11]Jaspe RC,Sulbarán YF,Loureiro CL,et al.Genetic diversity of hepatitis B virus and hepatitis C virus in human immunodeficiency virus type 1-co-infected patients from Venezuela.J Med Microbiol,2014,63(8):1099-1104.
[12]Cao WW,Zhou RR,Ou X,et al.Prevalence of hepatitis Bvirus,hepatitis C virus,human immunodeficiency virus and Treponema pallidum infections in hospitalized patients before transfusion in Xiangya hospital Central South University,China from 2011 to 2016.Bmc Infect Dis,2018,18(1):145.
[13]Tornesello ML,Buonaguro L,Tatangelo F,et al.Mutations in TP53,CTNNB1 and PIK3CA genes in hepatocellular carcinoma associated with hepatitis B and hepatitis C virus infections.Genomics,2013,102(2):74-83.
[14]Rehermann B,Bertoletti A.Immunological aspects of antiviral therapy of chronic hepatitis B virus and hepatitis C virus infections.Hepatology,2015,61(2):712-721.
[15]任宏,施阳,孟炜,等.上海市慢性乙、丙型肝炎疾病负担及其影响因素的生态系统模型研究.中华流行病学杂志,2017,38(1):37-42.
[16]Wu JC,Lee SD,Wang JY,et al.Correlation between hepatic hepatitis B core antigen and serum hepatitis B virus-DNAlevels in patients with chronic hepatitis B virus infections in Taiwan.Arch Pathol Lab Med,2015,59(4):463-468.
[17]Swaff RA.Correlation between alanine aminotransferase level,HCV-RNA titer and fibrosis stage in chronic HCV genotype 4infection.Egyp J Med Human Genet,2012,13(2):207-212.
[18]Kirisci O,Paksoy T,Caliskan A,et al.The relationship between serum DNA levels and serological markers,ALT and AST with liver histology in chronic hepatitis b patients.Acta Med Mediterranea,2016,32(6):1805-1811.
[19]Roshan B,Guzman G.Histological and clinical characteristics of patients with chronic hepatitis C and persistently normal alanine aminotransferase levels.Hepat Res Treat,2014,2014(1):760943.
[20]He D,Shang Q,An Y,et al.P709 liver histological inflammation of chronic hepatits B virus carriers with persistently normal alanine transamnase.J Hepatol,2014,60(1):S305-S305.
[21]Papatheodoridis GV,Manolakopoulos S,Liaw YF,et al.Follow-up and indications for liver biopsy in HBe Ag-negative chronic hepatitis B virus infection with persistently normal ALT:a systematic review.J Hepatol,2012,57(1):196-202.
[22]Ringelhan M,Heikenwalder M,Protzer U.Direct effects of hepatitis B virus-encoded proteins and chronic infection in liver cancer development.Dig Dis,2013,31(1):138-151.
[23]Goodman ZD,Makhlouf HR,Liu L,et al.Pathology of chronic hepatitis C in children:Liver biopsy findings in the Peds-Ctrial.Hepatology,2008,47(3):836-843.
[24]Fukuda R,Ishimura N,Niigaki M,et al.Serologically silent hepatitis B virus coinfection in patients with hepatitis C virus-associated chronic liver disease:Clinical and virological significance.J Med Virol,2015,58(3):201-207.
[25]Yoshizumi S,Hiroshi Y,Kyoji M,et al.The significance of hepatitis B virus DNA detected in hepatocellular carcinoma of patients with hepatitis C.Cancer,2015,88(11):2478-2486.
[26]Rd LRV,Kallan MJ,Tate JP,et al.Hepatic decompensation in antiretroviral-treated patients co-infected with HIV and hepatitis C virus compared with hepatitis C virus-monoinfected patients:a cohort study.Ann Intern Med,2014,160(6):369-379.
[2]封波,尚佳,武淑环,等.Y型聚乙二醇干扰素α-2b注射液治疗HCV基因2/3型CHC患者疗效和安全性的多中心随机对照试验研究.实用肝脏病杂志,2017,20(3):284-289.
[3]Kamarulzaman A,Reid SE,Schwitters A,et al.Prevention of transmission of HIV,hepatitis B virus,hepatitis C virus,and tuberculosis in prisoners.Lancet,2016,388(10049):1115-1126.
[4]DuskováD,Darebnícek L.Nucleic acid testing of hepatitis Bvirus,hepatitis C virus,and human immunodeficiency virus1,2 in blood donors in the General University Hospital,Prague.Acta Virologica,2014,58(2):146-151.
[5]Gong XQ,Yang JE,Tang JM,et al.A Mechanistic Assessment of the Discordance between Normal Serum Alanine Aminotransferase Levels and Altered Liver Histology in Chronic Hepatitis B.PLoS One,2015,10(7):e0134532.
[6]王琳,樊耀昕,丁洋,等.乙型肝炎病毒和丙型肝炎病毒慢性感染者肝组织病理学炎症及纤维化对比分析.中华肝脏病杂志,2017,5(6):419-423.
[7]中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版).实用肝脏病杂志,2016,19(3):Ⅴ-ⅩⅩⅢ.
[8]陈红松,窦晓光,段钟平,等.丙型肝炎防治指南(2015年更新版).实用肝脏病杂志,2015,29(12):1961-1979.
[9]谢琴秀,徐楠,江晓平,等.FibroScan对CHB病毒感染者肝纤维化评估的影响因素分析.中华肝脏病杂志,2016,24(9):659-664.
[10]Zuure F,Bil J,Visser M,et al.Prevalence of hepatitis B virus and hepatitis C virus infection among six ethnic groups living in Amsterdam,the Netherlands-The HELIUS study.JHepatol,2017,66(1):S405.
[11]Jaspe RC,Sulbarán YF,Loureiro CL,et al.Genetic diversity of hepatitis B virus and hepatitis C virus in human immunodeficiency virus type 1-co-infected patients from Venezuela.J Med Microbiol,2014,63(8):1099-1104.
[12]Cao WW,Zhou RR,Ou X,et al.Prevalence of hepatitis Bvirus,hepatitis C virus,human immunodeficiency virus and Treponema pallidum infections in hospitalized patients before transfusion in Xiangya hospital Central South University,China from 2011 to 2016.Bmc Infect Dis,2018,18(1):145.
[13]Tornesello ML,Buonaguro L,Tatangelo F,et al.Mutations in TP53,CTNNB1 and PIK3CA genes in hepatocellular carcinoma associated with hepatitis B and hepatitis C virus infections.Genomics,2013,102(2):74-83.
[14]Rehermann B,Bertoletti A.Immunological aspects of antiviral therapy of chronic hepatitis B virus and hepatitis C virus infections.Hepatology,2015,61(2):712-721.
[15]任宏,施阳,孟炜,等.上海市慢性乙、丙型肝炎疾病负担及其影响因素的生态系统模型研究.中华流行病学杂志,2017,38(1):37-42.
[16]Wu JC,Lee SD,Wang JY,et al.Correlation between hepatic hepatitis B core antigen and serum hepatitis B virus-DNAlevels in patients with chronic hepatitis B virus infections in Taiwan.Arch Pathol Lab Med,2015,59(4):463-468.
[17]Swaff RA.Correlation between alanine aminotransferase level,HCV-RNA titer and fibrosis stage in chronic HCV genotype 4infection.Egyp J Med Human Genet,2012,13(2):207-212.
[18]Kirisci O,Paksoy T,Caliskan A,et al.The relationship between serum DNA levels and serological markers,ALT and AST with liver histology in chronic hepatitis b patients.Acta Med Mediterranea,2016,32(6):1805-1811.
[19]Roshan B,Guzman G.Histological and clinical characteristics of patients with chronic hepatitis C and persistently normal alanine aminotransferase levels.Hepat Res Treat,2014,2014(1):760943.
[20]He D,Shang Q,An Y,et al.P709 liver histological inflammation of chronic hepatits B virus carriers with persistently normal alanine transamnase.J Hepatol,2014,60(1):S305-S305.
[21]Papatheodoridis GV,Manolakopoulos S,Liaw YF,et al.Follow-up and indications for liver biopsy in HBe Ag-negative chronic hepatitis B virus infection with persistently normal ALT:a systematic review.J Hepatol,2012,57(1):196-202.
[22]Ringelhan M,Heikenwalder M,Protzer U.Direct effects of hepatitis B virus-encoded proteins and chronic infection in liver cancer development.Dig Dis,2013,31(1):138-151.
[23]Goodman ZD,Makhlouf HR,Liu L,et al.Pathology of chronic hepatitis C in children:Liver biopsy findings in the Peds-Ctrial.Hepatology,2008,47(3):836-843.
[24]Fukuda R,Ishimura N,Niigaki M,et al.Serologically silent hepatitis B virus coinfection in patients with hepatitis C virus-associated chronic liver disease:Clinical and virological significance.J Med Virol,2015,58(3):201-207.
[25]Yoshizumi S,Hiroshi Y,Kyoji M,et al.The significance of hepatitis B virus DNA detected in hepatocellular carcinoma of patients with hepatitis C.Cancer,2015,88(11):2478-2486.
[26]Rd LRV,Kallan MJ,Tate JP,et al.Hepatic decompensation in antiretroviral-treated patients co-infected with HIV and hepatitis C virus compared with hepatitis C virus-monoinfected patients:a cohort study.Ann Intern Med,2014,160(6):369-379.