| Part 1 Investigation of clinical features of chronic HBV infection and companied with the other liver diseasesObjective: To clarify related factors of the disease progression by investigating the clinical and histopathological features of chronic HBV infection and companied with the other liver diseases. Further analysis the histopathological changes in patients with alanine aminotransferase(ALT) lower than 2 times of upper limit of normal(ULN). The reasonable treatment options might be suggested for patients with chronic HBV infection or companied with the other liver diseases.Methods: A retrospective study was carried out to analysis the clinical and histopathological features of 427 cases with chronic HBV infection and campanied with the other liver diseases from the Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University in January, 2007 to January, 2014. The data were collected including gender, age, the route of infection, family history, history of HBV infection and concurrent disease, positive signs, liver biochemical(ALT, AST, GGT, ALB, GLB),serological(HBs Ag, anti-HBs, HBe Ag, anti-HBe, anti-HBc), virological(HBV DNA) and pathological features(the degree of fat, the grade of inflammation, the stage of fibrosis). All the data were analyzed by SPSS 17.0, Chi-square test, One-Way ANOVA and rank sum test were used for statistic analysis.Results:1 General information and the types of HBV infection For all 427 cases with chronic HBV infection, 311 of the 427 cases(72.8%) were male, 116 of the 427 cases(27.2%) were female, the ratio of male to female was 2. 68:1.The age was between 16~75 years old. The mean(standard deviati on,SD) age was 37.16±11.62 years old. There were 119 peasants(27.9%),79(18.5%) leaders, 59(13.8%) workers, 31 students(7.3%), 51 office clerks(11.9%), and 88(20.6%) other careers. There were 238 cases(55.7%) infected by maternal-neonatal transmission, 189 cases(44.3%) had no family history of HBV infection or family history unknown. There were 66 cases(15.5%) with varying degrees history of drinking, 361 cases(84.5%) without it. There were 294(68.9%) HBe Ag-positive cases and 133(31.1%) HBe Ag-negative cases.2 Analysis of clinical and pathological diagnosis Total 290 cases(67.9%) were simple CHB, 137 cases(32.1%) were companied with the other liver diseases. All 78 cases(18.2%) were CHB with drugs or environmental toxic liver injury, 43 cases(10.1%) were CHB with steatosis, 3 cases(0.7%) were CHB with autoimmune phenomena, 13 cases(3.1%) were CHB with several factors injury.3 Comparison of liver biochemical and virological features between simple CHB and companied with the other liver diseases groups There were no significant differences for the serum level of albumin(album, ALB) and the load of HBV DNA.The M(QR) were ALB: 45(4.85) g/L vs 45(6.10) g/L(P>0.05);HBV DNA:5.00( 1.25)log IU/ml vs 5.00(2.00) log IU/ml(P>0.05). The levels of serum ALT: 78.00(152.00) U/L vs 60.50(92.00) U/L(P<0.01);AST: 53.00(87.50) U/L vs 45.50(49.25) U/L(P<0.05);GGT:67.00(72.50) U/L vs 42.50(45.00) U/L(P<0.01)in companied with the other liver diseases groups were significantly higher than those in simple CHB group.4 Comparison of histopathological features between simple CHB group and companied with the other liver diseases groups Among the 427 cases, there were 169 cases(39.6%) in <G2 and 258 cases(60.4%) in ≥G2. There were 225 cases(52.7%) in <S2 and 202 cases(47.3%) in ≥S2. There were no significant differences between simple CHB group and companied with the other liver diseases groups for the grade of inflammation and the stage of fibrosis(χ2=0.22, P=0.64; χ2=0.28, P=0.43). For liver inflammation <G2 and ≥G2, there were 117 cases(40.3%) and 173 cases(59.7%) in the simple CHB group, and there were 52 cases(38.0%) and 85 cases(62.0%) in the companied with the other liver diseases groups. For liver fibrosis <S2 and ≥S2, there were 152 cases(52.4%) and 138 cases(47.6%) in the simple CHB group, 73 cases(53.3%) and 64 cases(46.7%) in the companied with the other liver diseases groups.5 The virological, serological and pathological features in the chronic HBV infection patients with ALT≤2×ULN There were 121 cases of ALT≤2×ULN, 60 cases(49.6%) of inflammation grade <G2, 61 cases(50.4%) of inflammation grade ≥ G2. There were 66 cases(55.5%) showed <S2, 55 cases(45.5%) with fibrosis stage≥S2. There were 60 cases with high serum HBV DNA loads(>1×105IU/ml) and ULN<ALT≤2×ULN, 36 cases(60%) of inflammation grade≥G2, 22 cases(36.7%) with fibrosis stage≥S2. There were 61 cases with normal ALT for ages ≥ 30 years old, 31 cases(50.8%) of inflammation grade≥G2, 33 cases(54.1%) of liver fibrosis stage≥S2.Conclusion:1 In this study, the chronic HBV infections showed large gap, from children, young adults to the elderly people. Most of the patients were young adults and suffered from maternal-neonatal transmission. Chronic HBV infection patients usually came to hospital because of companied with the other liver diseases, such as drugs or environmental toxins injury, non alcoholic fatty liver disease and alcoholic liver disease. Comprehensive analysis the clinical characteristics, liver biochemical changes and necessary liver biopsy were helpful to make clear the pathogen, to take effective measures and avoid premature application of anti-HBV drugs.2 For chronic HBV infection patients whose ALT≤2×ULN, about 50% of them showed liver inflammation above G2, 45% of them fibrosis stage in S2. Those patients with serum HBV DNA loads(>1×105IU/ml) and ULN<ALT≤2×ULN, 60% of them showed liver inflammation above G2, 37% of them fibrosis stage reached S2.Those patients with normal ALT for ages≥30 years old, 50% of them ishowed liver inflammation above G2, 54% of them fibrosis stage reached S2. Therefore, early liver biopsy is an important strategy for chronic HBV infection patients to make accurate diagnosis and the timely effective antiviral treatment.Part 2 Study on correlation between PLT, ALT/PLT ratio with liver inflammation and fibrosis progression in chronic hepatitis B virus infection patientsObjective: Study on correlation between PLT, ALT/PLT ratio and histopathology of patients with chronic hepatitis B virus infection, to establish a new non-invasive accurately diagnosis marker for liver inflammation and fibrosis progression based on the routine clinical detection.Methods: The 290 simple CHB cases from outpatient service and hospitalized patients in department of traditional and western medical hepatology, the Third Hospital of Hebei Medical University in 2007 to 2014 were collected, and they were confirmed by liver biopsy. Routine detection items included peripheral blood platelet(platelet, PLT) count and serum ALT level, which were compared with the histopathology of liver tissue. All the data were analyzed by SPSS 17.0, analysis of variance and rank sum test were used for statistic analysis.Results:1 The relationship between PLT and liver inflammation, fibrosis progression 1.1 Liver inflammation can be devided into four grades, there were 96 cases in G0~1 group, 21 cases in G1+~2 group, 108 cases in G2+~3 group and 65 cases in G3+~4 group, the mean(SD) value of PLT were 218.91±58.93, 219.56±57.79, 200.93±77.57 and 138.97±62.39 in the four groups. There were significant difference among the four groups(P=0.000). No significant difference was observed between G0~1 and G1+~2 group(P=0.99). There were significant difference between G0~1,G1+~2 and G2+~3,G3+~4; G2+~3 and G3+~4(P=0.000) in PLT value. It was suggested that PLT related with the progression of liver inflammation(r=-0.556, P=0.000). The PLT value decreased gradually with the aggravation of liver inflammation. The chronic HBV infection patients with PLT<200 ×109/L suggested liver inflammation beyond G2.1.2 Liver fibrosis also can be classified into four stages. There were 127 cases in S0~1 group, 25 cases in S1+~2 group, 56 cases in S2+~3 group and 82 cases in S3+~4 group, the mean(SD) value of PLT were 233.13±61.24, 227.29±49.89, 194.43±67.12, 141.31±53.84×109/L in the four groups. The PLT value decreased gradually with the progression of liver fibrosis. There were significant differences among the four groups(r=-0.525, P=0.000). No significant difference was observed in groups S0~1 and S1+~2(P=0.88). There were significant differences between S0~1, S1+~2 and S2+~3, S3+~4; S2+~3 and S3+~4(P=0.000) in PLT value. It was suggested PLT value is an important index to judge the severity of disease and the progression of liver fibrosis. The PLT value under 194×109/L predicted liver fibrosis beyond S2.2 The relationship between ALT/PLT ratio and liver inflammation, fibrosis progression2.1 In G0~1, G1+~2, G2+~3 and G3+~4 groups, the ratios M(QR) of ALT/PLT were 0.185(0.25)、0.19(0.21)、0.405(0.51)、0.88(1.44) respectively. There were significant differences among the four groups(P=0.02). No significant difference was observed between G0~1 and G1+~2 group(P=0.11). There were significant differences between G0~1,G1+~2 and G2+~3,G3+~4; G2+~3 and G3+~4(P=0.000) in ratio of ALT/PLT. It was suggested that the ratio of ALT/PLT increased(r=0.671, P=0.000) with the aggravation of liver inflammation in patients with chronic hepatitis B graded beyond G2.2.2 In S0~1, S1+~2, S2+~3 and S3+~4 groups, the ratios M(QR) of ALT/PLT were 0.22(0.35)、0.24(0.42)、0.47(0.81)、0.705(1.01), respectively. The ratio of ALT/PLT increased gradually with the aggravation of liver fibrosis. There were significant differences among the four groups(r=0.532, P=0.000). No significant difference was observed between S0~1 and S1+~2 group(P=0.97). There were significant differences between S0~1, S1+~2 and S2+~3, S3+~4, S2+~3 and S3+~4(P=0.000) in ratio of ALT/PLT.Conclusion:The PLT value associated with the aggravation of liver inflammation, which showed decreasing trend. The chronic HBV infection patients with PLT<200×109/L suggested liver inflammation beyond G2. The ratio of ALT/PLT increased gradually with the progression of liver fibrosis. |
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