HBV DNA 低水平患者肝组织炎症活动度和纤维化程度的影响因素分析.

Objective To investigate liver pathological features and related factors in patients with low-level HBV DNA, and to provide a basis for evaluating the conditions of such patients. Methods A total of 137 patients with an HBV DNA level of ＜2000 IU/ml and ＞20 IU/ml who attended The Third People′s Hospital of Kunming from January 2014 to December 2017 were enrolled. Liver pathological examination was performed for all patients. Of all patients, 44 had grade 1 (G1) liver inflammation, 84 had grade 2 (G2) liver inflammation, and 9 had grade 3 (G3) liver inflammation; as for fibrosis stage, 2 had S0 fibrosis, 67 had S1 fibrosis, 56 had S2 fibrosis, 9 had S3 fibrosis, and 3 had S4 fibrosis. The correlation of liver inflammation grade and fibrosis stage with age, sex, duration of HBV infection, blood biochemistry, HBsAg level, and HBV DNA was analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and univariate and multivariate one-way non-conditional logistic regression analyses were used to investigate the influencing factors for ≥G2 liver inflammation and ≥S2 fibrosis. ResultsThere were significant differences in HBsAg, platelet count (PLT), diameter of the splenic vein, and spleen thickness between the G1, G2, and G3 groups (H=7.135, 7.458, 7.588, and 10.150, all P＜0.05), and there were also significant differences in HBsAg, PLT, diameter of the portal vein, diameter of the splenic vein, and spleen thickness between the S0, S1, S2, S3, and S4 groups (H=20.564, 12.065, 26.171, 14.720, and 13.725, all P＜0.05). Of all 137 patients, 44 had no or mild inflammation and necrosis (＜G2 group) and 93 had moderate or severe inflammation and necrosis (≥G2 group); age, alanine aminotransferase, alkaline phosphatase (ALP), white blood cell count, diameter of the splenic vein, and spleen thickness, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis (α=0.15), and the results showed that age (odds ratio ［OR］=1.045, P＜0.05), ALP(OR=1.019, P＜0.05), and spleen thickness (OR=1.150, P＜0.05) were independent risk factors for ≥G2 liver inflammation in the patients with low-level HBV DNA. Of all 137 patients, 69 had no or mild liver fibrosis (＜S2 group) and 68 had moderate or severe liver fibrosis (≥S2 group); total bilirubin, HBsAg, PLT, and diameter of the portal vein, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis (α=0.15), and the results showed that HBsAg (OR=2.065), PLT(OR=0.988), and diameter of the portal vein (OR=2.464) were independent risk factors for ≥S2 liver fibrosis in the patients with low-level HBV DNA. Conclusion The majority of patients with low-level HBV DNA have the indication of antiviral therapy. Age, ALP, and spleen thickness are closely associated with liver inflammation grade in patients with low-level HBV DNA, and HBsAg, PLT, and diameter of the portal vein are closely associated with liver fibrosis. [ABSTRACT FROM AUTHOR]