慢性乙型肝炎病理与临床诊断的一致性  

Consistency of pathology and clinical diagnosis of chronic hepatitis B

作　　者：于晓辉[1] 赵连三[1] 张秀辉[2] 谭明珍[1] 吴雄志[1] 许倩[1] 马颖[1] 熊中华[1] 

机构地区：[1]四川大学华西医院感染性疾病中心人类疾病生物治疗教育部重点实验室,成都610041 [2]四川大学华西医院病理科

出　　处：《胃肠病学和肝病学杂志》2005年第1期71-73,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的　在诊断慢性乙型肝炎的病情活动度时 ,肝组织病理学检查是决定性的依据 ,但由于难以普遍实施 ,故往往以病史、症状、体征、化验检查资料进行临床诊断。本研究旨在评价慢性乙型病毒性肝炎临床与病理诊断的符合性。方法　采用肝穿活检的方法 ,对肝组织进行镜下形态观察和免疫组织化学检查 ,作出相应的病理学诊断。临床与病理诊断作统计学Kappa检验与列联表关联分析。结果　Kappa值 =0 .3 2 1(P =0 .0 0 1) ,SpearmanCorrelation =0 42 5 (P =0 .0 0 1)。临床诊断与病理诊断的总符合率为64 .81%,慢性乙肝轻度、中度、重度的符合率分别为 90 .0 0 %、2 7.78.0 0 %、5 0 .0 0 %。结论　慢性乙肝病情活动度的临床诊断与病理诊断的一致性不强 ,故对于没有禁忌症的患者应进行肝活检 ,特别是对于中、重度的患者 ,更应该行肝穿活检 ,以明确诊断 ,估计预后。Objective Although the diagnosis of chronic viral hepatitis B relies on liver histopathological examination, it is difficult to carry out widely. Therefore, the cilinical diagnosis of hepatitis B bases on case history, symptoms, signs and biochemical tests. The purpose of the study is to assess consistency of the clinical and histopathological diagnosis for patients with chronic viral hepatitis B.Methods Using traditional technique of liver biopsy, we examined the liver tissue by the microscope and in immunohistochemical method to get histopathological diagnosis.Then the dates about clinical and histopathological diagnosis were analyzed by Kappa test and Spearman analysis.Results Kappa value=0.321 (P=0.001),Spearman correlation=0.425(P=0.001), The general coincidence of clinical and histopathological diagnosis is 64.81% and the coincidence of mild, medium,severe hepatitis B were 90.00%, 27.78%, 50.00% respectively.Conclusion The weak consistency was observed between the clinical and histopathological diagnosis for patients with chronic viral hepatitis B. Therefore, it was necessary to perform the liver biopsy for patients without clinical contraindication to establish diagnosis and evaluate prognosis. Especially, the patients with medium and severe chronic hepatitis B should make liver biopsy.

关 键 词：临床诊断 慢性乙型肝炎 病理诊断 病情活动 慢性乙肝 活检 患者 形态观察 关联分析 

分 类 号：R512[医药卫生—内科学] R593.241[医药卫生—临床医学]