281例慢性乙型肝炎患者肝脏组织临床病理学研究  

A retrospective analysis of liver histopathology in 281 cases with chronic hepatitis B

作　　者：李勇年[1] 吴炜强[1] 翟佩任[1] 李梅玲[1] 王彩云[2] 高建兴[1] 王常利[3] 燕青松[1] 周正源[1] 那军[4] 

机构地区：[1]解放军第323医院感染科暨肝病内科,西安市710054 [2]第四军医大学病理教研室 [3]解放军第323医院病理科,西安市710054 [4]解放军第323医院中心实验室,西安市710054

出　　处：《中华实验和临床感染病杂志（电子版）》2009年第4期23-27,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的分析现阶段慢性乙型肝炎患者肝脏组织病理学特点。方法对281例慢性乙型肝炎住院患者不同肝脏组织学病变程度与血液生化、乙型肝炎病毒标志物等临床实验室检查指标以及腹部超声检查进行对比分析。结果肝脏不同炎症活动度组中,各组间的平均年龄有显著差异;G1与G3、G2与G3组的外周血白细胞和血小板计数有显著差异;G1与G2、G3组的血清谷氨酸氨基转移酶有显著差异;G1、G2、G3组的腹部超声检查有显著差异。肝脏不同纤维化程度组中,S1、S2与S3、S4组的平均年龄有显著差异;S1、S2与S4组的外周血白细胞计数有显著差异;S1、S2与S3和S4的血小板计数和腹部超声检查有显著差异。未观察到肝脏不同炎症活动度组和肝脏不同纤维化组在HBeAg状态、HBV DNA水平和A/G比例之间存在显著差异。结论慢性乙型肝炎患者肝脏组织病理学改变与血常规、肝脏功能及肝脏影像学检查结果一致,而与血清乙型肝炎病毒抗原状态和病毒血症严重程度无明显相关。与未采用抗乙型肝炎病毒药物时期和乙型肝炎病毒耐药突变株出现之前相比,现阶段慢性乙型肝炎患者肝脏组织病理学特点未发生明显变化。慢性乙型肝炎患者肝脏组织病理学检查具有临床价值,应予以重视。Objective To study the cause of chronic hepatitis B （CHB） and compare the severity of liver histopathology with the routine laboratory test in patients with chronic hepatitis B at present antiviral age. Methods The relationship between different degree of necroinflammatory disease activity （grade） or extent of disease progression with fibrosis （stage） and blood, biochemistry, HBeAg status, HBV DNA serum level and abdomen ultrasonic imaging were explored in a total of 281 inpatients with CHB. Results The re- suits showed that the liver histopathology seems to progress worse both in the grade and stage of liver histopa- thology with the growing of age. The correlations were also observed in different histological grade （ G1 or G2 vs G3） or stage （S1 or $2 vs $4 and S1 or $2 vs $3 or $4） and the count of white blood cell and platelet, the different grade （G1 vs G2 or G3 ） and the level of alanine aminotransferanse （ALT） in the serum, the different grade （G1 vs G2 or G3 and G2 vs G3 ） or stage （S1 or $2 vs $3 or $4 ） and abnormal liver and spleen ultrasonic imaging. The severity of histopathology in the grade and stage did not show correlation to sex, albumin/globulin, HBeAg status and HBV DNA level in serum among CHB patients. Conclusions Comparing with the periods without antiviral treatment, there are no obvious changes in characteristics of liv- er histopathology, laboratory test and liver and spleen ultrasonic imaging in patients with CHB. The severity of histopathology in grade and stage seems correlated to the characteristics achieved by laboratory tests and ultrasonic imaging, but not parallel to the HBeAg status and HBV DNA level in patients of CHB.

关 键 词：慢性乙型肝炎 乙型肝炎病毒DNA 肝活检 肝脏组织病理学 

分 类 号：R512.62[医药卫生—内科学] R512.63[医药卫生—临床医学]