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目的研究丙氨酸氨基转移酶(ALT)<2倍正常值上限(ULN)的慢性乙型肝炎(乙肝)患者肝组织病理及临床特点,探讨ALT为1～2ULN的慢性乙肝抗病毒治疗时机。方法回顾性分析314例慢性乙型肝炎患者不同ALT水平时的肝组织病理情况,其与既往ALT为1～2ULN的相关性以及ALT水平预测肝脏炎症分级为G2以上的灵敏度(SEN)与特异性(SPE)。结果 ALT<30 U/L、<40 U/L、<60U/L、<70U/L、<80U/L及≥80U/L时,肝脏炎症分级为G2以上者分别占1.1%、3.0%、7.1%、7.5%、8.6%及42.0%;纤维化分期为S2以上者分别占53.3%、55.2%、55.0%、54.8%、53.1%及57.9%。肝脏纤维化程度与既往反复ALT为1～2 ULN密切相关。以ALT≥60 U/L(1.5 ULN)、≥80U/L(2ULN)为界时,预测肝脏炎症分级为G2以上的SEN分别为70%、58%,SPE分别为74.2%、84.8%。结论 ALT<2ULN者肝纤维化分期为S2以上者占50%以上。ALT为1～2ULN的慢性乙型肝炎患者,若无法作肝活检或作无创肝纤维化程度评估,ALT≥60U/L(1.5ULN)可作为抗病毒治疗的筛选指标,比ALT≥80U/L(2ULN)为界限更优。
Objective To investigate the histopathological features and clinical features of chronic hepatitis B (AL) patients with chronic hepatitis B (ULN) <2 times the upper limit of normal (ULN), and to investigate the timing of antiretroviral therapy for chronic hepatitis B patients with ALT of 1 ~ 2ULN. Methods A retrospective analysis of 314 cases of chronic hepatitis B patients with different levels of ALT liver histopathology, and its previous ALT of 1 ~ 2ULN correlation and ALT levels predict the sensitivity of the liver inflammation grade (G2) above the sensitivity (SEN) and specificity (SPE). Results When the ALT was less than 30 U / L, less than 40 U / L, less than 60 U / L, less than 70 U / L, less than 80 U / L and more than 80 U / L, 7.1%, 7.5%, 8.6% and 42.0% respectively. The patients with fibrosis staging S2 accounted for 53.3%, 55.2%, 55.0%, 54.8%, 53.1% and 57.9% respectively. The degree of liver fibrosis is closely related to the previous repeated ALT of 1 ~ 2 ULN. When the ALT≥60 U / L (1.5 ULN) and ≥80U / L (2ULN) were used as the boundary, the SEN with G2 or higher hepatic inflammation grade were predicted to be 70% and 58%, respectively, and the SPE were 74.2% and 84.8% respectively. Conclusion ALT <2ULN liver fibrosis staging more than S2 accounted for more than 50%. ALT of 1 ~ 2ULN in patients with chronic hepatitis B, if not for liver biopsy or non-invasive assessment of the degree of non-liver fibrosis, ALT ≥ 60U / L (1.5ULN) can be used as an antiviral therapy screening index than ALT ≥ 80U / L (2ULN) as a better boundary.