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慢性乙型肝炎肝纤维化进展与丙氨酸氨基转移酶演变关联性的探讨

作者：赖长祥何清唐奇远唐情容何逸洲廖雪姣白冰张斌李知玉

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出版年,卷(期):页码：2015,7(4):31-34

摘要：

摘要:目的探讨慢性乙型肝炎（chronic hepatitis B，CHB）患者肝纤维化进展与丙氨酸氨基转移酶
（ALT）演变规律的相关性。方法选取深圳市第三人民医院2000年1月至2011年1月住院并行肝脏组
织活检的510例慢性乙型肝炎患者，经肝组织活检术明确其纤维化程度，根据纤维化的进展分为两个
阶段，早中期阶段（S0→S1→S2）与中后期阶段（S2→S3→S4），两阶段均按ALT分成A[ALT ≤ 正
常值上限（ULN，ULN = 40 U/L）]、B（ULN ＜ ALT ≤ 2 × ULN）、C（ALT ＞ 2 × ULN）3组。
探讨两个阶段纤维化进展与ALT各组之间的相关性。结果 510例患者中，男性391例（76.67%），女
性119例（23.33%），纤维化早中期患者404例（S0期28例，S1期261例，S2期115例），随着纤维化
进展（S0→S1→S2），纤维化与ALT之间的差异有统计学意义（χ 2 = 25.377，P = 0.00)。三组ALT经
过χ 2 分割法（即Bonferroni法）比较，检验水准调整为0.05/3（即0.017），各组之间的ALT水平差异均
有统计学意义（P值均＜ 0.017）。经Spearman等级相关分析r = 0.137，即随着纤维化进展，血清ALT
呈逐渐上升趋势。纤维化中后期患者221例（S2期115例，S3期67例，S4期39例），随着肝纤维化进
展（S2→S3→S4），纤维化与ALT之间的差异无统计学意义（χ 2 = 6.365，P = 0.173）。三组ALT经过
χ 2 分割法比较，检验水准调整为0.05/3（即0.017），各组之间的ALT水平差异亦无统计学意义（P值
均＞ 0.017）。结论在CHB肝纤维化进展过程中，肝纤维化早中期阶段对应的ALT呈现逐渐升高的趋
势，而中后期阶段与ALT无相关性。

Abstract: Objective To investigate the relationship between stages of liver fibrosis and alanine amino
transferase (ALT). Methods Total of 510 cases of chronic hepatitis from January 2000 to January 2001 in
the Third People’s Hospital of Shenzhen Affiliated to Guangdong Medical University were selected. Liver
biopsy was performed to evaluate the liver fibrosis. The patients were divided into two different stages
according to the progression of liver fibrosis, the early-middle stages (S0→S1→S2) and the middle-late
stages (S2→S3→S4). In these two stages, three subgroups were divided into group A (ALT ≤ ULN, ULN =
40 U/L), group B (ULN ＜ ALT ≤ 2 × ULN) and group C (ALT ＞ 2 × ULN) according to ALT levels. The
relationship between fibrosis progressing and ALT levels in each stage was furtherly investigated. Results Of
the 510 patients, 391 (76.67%) were male and 119 (23.33%) were female. Among these patients, 404 cases
were in the early-middle stages (28 cases in S0, 261 cases in S1 and 115 cases in S2) and with the progression
of liver fibrosis, the difference between fibrosis and ALT was statistically significant (χ 2 = 25.377, P = 0.00).
“Bonferroni” method was used to test the ALT levels of three subgroups and the inspection level was adjusted to 0.05/3 (0.017). ALT levels in each group had statistical differences (P ＜ 0.017) and the value of “r” was
0.137 by Spearman method, which meant with the progression of fibrosis, ALT presented an increased trend.
Total of 221 patients were in the middle-late stages (115 cases in S2, 67cases in S3 and 39 cases in S4), and
the differences between fibrosis and ALT had no statistical significance (χ 2 = 6.365, P = 0.173) in this stage.
Similarly, differences of ALT levels in each group had no statistical significance (P ＞ 0.017) according to the
above method. Conclusion During the progress of liver fibrosis in CHB, ALT presented a gradually increased
trend in the early-middle stages and had no relationship in the middle-late stages.

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