Objective: To analyze the hepatic tissue inflammatory activity and influencing factors in HBeAg-positive patients during normal alanine aminotransferase (ALT) and indeterminate phases so as to provide a basis for evaluating the disease condition. Methods: Patients with HBeAg-positive with normal ALT and HBV DNA levels below 2 × 10(7) IU/ml from January 2017 to December 2021 were selected as the study subjects. A histopathologic liver test was performed on these patients. Age, gender, time of HBV infection, liver function, HBsAg level, HBV DNA load, genotype, portal vein inner diameter, splenic vein inner diameter, splenic thickness, and others of the patients were collected. Significant influencing factors of inflammation were analyzed in patients using logistic regression analysis, and its effectiveness was evaluated using receiver operating characteristic (ROC) curves. Results: Of the 178 cases, there were 0 cases of inflammation in G0, 52 cases in G1, 101 cases in G2, 24 cases in G3, and one case in G4. 126 cases (70.8%) had inflammatory activity ≥ G2. Infection time (Z=-7.138, P<0.001), γ-glutamyltransferase (t =-2.940, P=0.004), aspartate aminotransferase (t =-2.749, P=0.007), ALT (t =-2.153, P=0.033), HBV DNA level (t =-4.771, P=0.010) and portal vein inner diameter (t =-4.771, P<0.001) between the ≥G2 group and < G2 group were statistically significantly different. A logistic regression analysis showed that significant inflammation in liver tissue was independently correlated with infection time [odds ratio (OR)=1.437, 95% confidence interval (CI): 1.267-1.630; P<0.001)] and portal vein inner diameter (OR=2.738, 95% CI: 1.641, 4.570; P<0.001). The area under the curve (AUROC), specificity, and sensitivity for infection time and portal vein inner diameter were 0.84, 0.71, 0.87, 0.72, 0.40, and 0.95, respectively. Conclusion: A considerable proportion of HBeAg-positive patients have inflammation grade ≥G2 during normal ALT and indeterminate phases, pointing to the need for antiviral therapy. Additionally, inflammatory activity has a close association with the time of infection and portal vein inner diameter.
目的： 分析HBeAg阳性丙氨酸转氨酶（ALT）正常不确定期患者肝脏组织炎症活动度，为HBeAg阳性ALT正常不确定期患者的病情判断提供依据。 方法： 选取2017年1月-2021年12月HBeAg阳性ALT正常HBV DNA水平低于2×10(7) IU/ml者作为研究对象，对该类患者进行肝组织病理学检查，并收集患者年龄、性别、感染HBV时间、肝功能、HBsAg水平、HBV DNA载量、基因型、门静脉内径、脾静脉内径、脾脏厚度等，logistic回归分析患者显著炎症的影响因素，受试者操作特征（ROC）曲线评价其效能。 结果： 178例患者中，炎症分级：G0有0例、G1有52例、G2有101例、G3有24例、G4有1例。炎症活动≥G2者有126例（70.8%）。炎症活动≥G2组与<G2组比较，感染时间（Z = -7.138，P < 0.001）、γ-谷氨酰转移酶（t = -2.940，P=0.004）、天冬氨酸转氨酶（t = -2.749，P=0.007）、ALT（t = -2.153，P=0.033）、HBV DNA水平（t = -4.771，P=0.010）、门静脉内径（t = -4.771，P<0.001），差异均有统计学意义。Logistic回归多因素分析肝组织显著炎症与感染时间[比值比（OR）＝1.437，95%可信区间（CI）：1.267～1.630；P <0.001）]和门静脉内径（OR＝2.738，95%CI:1.641，4.570；P <0.001）均独立相关。感染时间和门静脉内径曲线下面积、特异性、敏感性分别为：0.84、0.71、0.87；0.72、0.40、0.95。 结论： HBeAg阳性ALT正常不确定期患者中，有相当比例的患者炎症分级≥G2，具有抗病毒治疗的指征，其炎症活动度与感染时间和门静脉内径密切相关。.
Keywords: Alanine transaminase; Chronic hepatitis B; Hepatitis B e antigen; Indeterminate phrase; Liver inflammation.