Clinical Study On Serology And Pathological Analysis Of Liver Tissue In Patients With Chronic Hepatitis B Complicated With Pulmonary Tuberculosis With Mild Elevation Of ALT

Objective: To investigate the differences in serology and hepatic pathology between the chronic hepatitis B(CHB) with pulmonary tuberculosis patients and pure CHB patients with mild elevation of ALT before anti-tuberculosis treatment. Methods: 79 CHB with pulmonary tuberculosis patients of mildly elevated ALT(40<ALT<80 U/L) were collected as the co-infection group from January 2009 to December 2014, and 79 CHB patients of 40<ALT<80 U/L were selected randomly in the same period as the CHB group, and to compare main liver function indexes, prothrombin time(PT), index of virus, the hepatic tissue inflammation and fibrosis between the two groups. Results: The levels of serum albumin(ALB) and acetylcholinesterase(CHE) in the co-infection group were lower than those in the CHB group(P <0.05); The number of CD4+ T lymphocytes and CD20+ B lymphocytes in the co-infection group were lower than those in the CHB group, while CD8+ T lymphocytes was higher(P <0.05); patients of inflammation with two or more(≥G2) account for 74.7% in the co-infection group, which was 59.5% in the CHB group, the difference was statistically significant(χ2=4.128, P<0.05); patients of fibrosis with two or more(≥S2) account for 51.9% in the co-infection group, which was 44.3% in the CHB group, the difference was no statistically significant(χ2=0.913,P>0.05); Ishak score system showed that the co-infection group were higher than those of the CHB group in piecemeal necrosis and portal area inflammation score and total score(2.45±1.19 vs 2.05±1.28, t=2.055, p=0.042; 2.70±1.22 vs 2.32±1.08, t=2.068, p=0.040; 13.16±6.51 vs 11.22±5.72, t=1.984, p=0.049), the differences were statistically significant, but there were no significant differences in the confluent necrosis, focal(dot) soluble necrosis, apoptosis, and focal inflammatory changes,and fibrosis(P>0.05).Conclusions: Compared with the CHB patients, ALB and CHE levels are lower than the CHB with PTB patients; Compared with the CHB patients, CD4+ T lymphocytesin and CD20+ B lymphocytes in the liver tissues of the CHB with PTB patients are lower than those in the CHB patients, while CD8+ T lymphocytesin is higher; Most of the CHB patients with 40<ALT<80 U/L have medium or surpassing hepatic inflammation and fibrosis, requiring antiviral therapy; Compared with the CHB patients, the co-infection patients have a higher degree of hepatic inflammation damage and Ishak scores, although the ALT is 40 <ALT <80 U/L among most patients, they are still have the treatment of indications; the co-infection patients should be encouraged to take the liver biopsy mobilization examination, fully assessing the degree of patients’ hepatic inflammation and fibrosis. All these measures are propitious to customize the reasonable anti-tuberculosis and anti-HBV treatment plan in clinic.