慢性肝炎临床病理诊断的探讨(附617例慢性乙型肝炎临床病理资料分析)  

Study on the clinical and pathological diagnosis of chronic hepatitis B

作　　者：许家璋[1] 杨志国[1] 高蕾[1] 张泰和[2] 刘健虎[3] 李育贤[4] 齐承义[5] 宁文锡[6] 黄维德[7] 严家春[8] 

机构地区：[1]解放军第81医院,南京210002 [2]解放军南京总医院,南京210002 [3]解放军第101医院,江苏无锡210404 [4]解放军第81医院当涂分院,安徽当涂343100 [5]解放军第101医院苏州分院,江苏苏州215007 [6]解放军第359医院,江苏镇江212001 [7]解放军第98医院,浙江湖州313000 [8]解放军第123医院,安徽蚌埠233015

出　　处：《东南国防医药》2003年第3期161-163,共3页Military Medical Journal of Southeast China

摘　　要：目的　探讨慢性肝炎临床病理分级分期的诊断指标。方法　从 5 80 0例经临床和病理确诊的各型病毒性肝炎及肝病中 ,按临床和病原学诊断排除慢性乙型肝炎重叠感染及其他类型的病毒性肝炎 ,随机抽取近 1 0年来单一 HBV感染的慢性乙型肝炎 61 7例 ,进行组织学分级分期量化分析 ,将慢性肝炎肝组织炎症活动程度分为 1～ 4级 (G1～ 4) ,肝纤维化程度分为 0～ 4期 (S0～ 4)。取肝活检时临床及血生化的主要检测指标对照统计分析。结果　 61 7例慢性乙型肝炎中 ,慢性乙型肝炎 (轻度 ) ,G1～ 2 ,S0～ 1 ,2 35例 ,占 38.1 % ;慢性乙型肝炎 (中度 ) ,G2～ 3,S2 ,2 0 0例 ,占 32 .4% ;慢性乙型肝炎 (重度 ) G3,S3,93例 ,占 1 5.1 % ;肝炎肝硬化早期 ,G1～ 4,S4,89例 ,占 1 4 .4%。对照血生化 9项主要指标结合临床分析提示 ,反映蛋白质代谢的四项指标 :即白蛋白 (A) ,球蛋白 (G) ,A/ G,γ- GP对临床分型诊断价值更为可靠 ,其次为 TSB,ALG,AST。结论　慢性肝炎临床病理量化诊断指标简单易行 ,便于临床医师掌握 。Objective To investigate the diagnosis of clinical and pathological grading and staging of chronic hepatitis B (CHB). Methods Excluded other types of viral hepatitis superinfection, 617 patients with hepatitis B virus only were chosen randomly from 5800 patients with variants hepatitis virus and/or hepatic disease who were diagnosed clinically and pathologically. The pathological changes were analyzed using histological grading and staging, which were classified into 4 grades (1~4 grade) based on histological inflammatory degree and 5 stages (0~4 stage) based on hepatic fibrosis degree. Clinical and blood biochemical indexes served as control. Results Among 617 cases of chronic hepatitis B, mild hepatitis B (G1~2,S0~1) were 235 cases ( 38.1% ), moderate B (G2~3,S2) were 200 cases (32.4%), severe hepatitis B (G3,S3) were 93 cases (15.1%),early liver cirrhosis of hepatitis B (G1~4,S4) were 89 cases (14.4%). It suggested that albumin (A), globulin (G), A/G, γ GP be more dependable for clinical diagnosis by comparing blood biochemical indexes. Conclusions Quantificational clinical pathological diagnosis indexes were simple and accessible for physician to grasp. It was of great value to diagnose hepatitis B.

关 键 词：慢性乙型肝炎 临床病理 量化诊断指标 

分 类 号：R512.6[医药卫生—内科学]