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摘要：
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摘要：目的 分析抗凝血酶Ⅲ（antithrombin Ⅲ，AT-Ⅲ）活性与慢性乙型肝炎病毒（hepatitis B virus，
HBV）感染者肝纤维化程度的相关性。方法 选取2017年6月至2019年11月在安徽医科大学第二附
属医院行肝组织活检的102例慢性HBV感染者为研究对象，检测患者丙氨酸氨基转移酶（alanine
aminotransferase，ALT）、AT-Ⅲ活性及D-二聚体水平，根据AT-Ⅲ活性将患者分为减低组（＜ 75%，
27例）和正常组（75%～125%，75例），比较两组间ALT和D-二聚体水平的差异。根据肝组织病理
进行肝脏炎症活动度分级（G）和纤维化分期（S），比较不同肝脏炎症活动度分级及纤维化分期患
者AT-Ⅲ活性的差异。AT-Ⅲ活性与肝脏炎症活动度和肝纤维化分期的相关性采用Spearman秩相关检
验。结果 AT-Ⅲ活性减低组和正常组患者ALT水平（中位数：60 U/L vs 39 U/L）差异有统计学意义
（z = -2.56，P = 0.01）；D-二聚体水平（中位数：0.21 mg/L vs 0.25 mg/L）差异无统计学意义（z =
-1.42，P = 0.16）。肝脏炎症活动度G1、G2、G3分别有62例、34例、6例，AT-Ⅲ活性分别为83.00%
（78.00%，90.05%）、（79.19 ± 17.88）%、（77.02 ± 18.16）%，差异无统计学意义（H = 1.338，P =
0.512）。肝纤维化程度S1期、S2期、S3期、S4期分别有52例、23例、16例、11例；AT-Ⅲ活性分别
为（84.45 ± 9.87）%、85.40%（74.00%，96.00%）、（77.56 ± 14.03）%、（66.61 ± 25.84）%，差
异有统计学意义（H = 13.886，P = 0.003），其中S1期和S2期患者AT-Ⅲ活性均显著高于S4期患者（t =
2.255，P = 0.046；z = -2.670，P = 0.008）。Spearman相关性分析表明，AT-Ⅲ活性与肝脏炎症活动
度无显著相关性（r = -0.44，P = 0.253），而与纤维化程度呈负相关（r = -0.296，P = 0.002）。结论
AT-Ⅲ活性与慢性HBV感染者肝纤维化程度相关，可能成为一种新的肝脏病理的无创诊断指标。
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Abstract: Objective To analyze the correlation between activity of antithrombin Ⅲ (AT-Ⅲ) and the degree
of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection. Methods A total of 102 patients
with chronic HBV infection who underwent liver biopsy in the Second Affiliated Hospital of Anhui Medical
University from June 2017 to November 2019 were selected. The levels of alanine aminotransferase (ALT),
AT-Ⅲ activity and D-dimer were detected. The patients were divided into AT-Ⅲ reduced group (＜ 75%,
27 cases) and normal group (75%～125%, 75 cases) according to the AT-Ⅲ activity, the levels of ALD and
D-dimer were compared between the two groups. Liver inflammatory activity grades (G) and fibrosis stages (S)
were determined by liver histopathology. The activity of AT-Ⅲ between different liver inflammatory activity
grades and fibrosis stages were compared. The correlation of AT-Ⅲ activity, liver inflammation activity
and liver fibrosis stage were analyzed by Spearman rank correlation test. Results There was a statistically
significant difference in ALT level (median: 60 U/L vs 39 U/L) between patients in AT-Ⅲ activity reduced
group and normal group (z = -2.56, P = 0.01). There was no statistically significant difference in D-dimer
level (median: 0.21 mg/L vs 0.25 mg/L) between patients in AT-Ⅲ activity reduced group and normal
group (z = -1.419, P = 0.156). The cases of hepatic inflammatory activity G1, G2 and G3 were 62, 34 and 6,
respectively, the AT-Ⅲ activity were 83.00% (78.00%, 90.05%), (79.19 ± 17.88)% and (77.02 ± 18.16)%,
respectively, the difference was not statistically significant (H = 1.338, P = 0.512). The cases of fibrosis stage
S1, S2, S3 and S4 were 52, 23, 16 and 11, respectively, the AT-Ⅲ activity were (84.45 ± 9.87)%, 85.40% (74.00%,
96.00%), (77.56 ± 14.03)% and (66.61 ± 25.84)%, respectively, the difference was statistically significant
(H = 13.886, P = 0.003). The AT-Ⅲ activity of patients with S1 stage and S2 stage were significantly higher
than that of S4 stage (t = 2.255, P = 0.046; z = -2.670, P = 0.008). Spearman rank correlation test showed
that AT-Ⅲ activity had no correlation with inflammation activity (r = -0.44, P = 0.253), but was negatively
correlated with the degree of liver fibrosis (r = -0.296, P = 0.002). Conclusions AT-Ⅲ activity is significantly
related to the degree of liver fibrosis in patients with chronic HBV infection, and may become a new non-
invasive diagnostic indicator of liver pathology.
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