慢性乙型肝炎患者肝穿病理与临床指标的关系  

Evaluation of Correlation between Hepatic Pathohistology of Biopsies and Clinical Indices in 359 Patients with Chronic Hepatitis B

作　　者：何伶俐[1] 雷学忠[1] 陈竹[2] 陈恩强[1] 徐辉[1] 

机构地区：[1]四川大学华西医院感染性疾病中心,成都610041 [2]成都市传染病医院

出　　处：《华西医学》2010年第3期474-478,共5页West China Medical Journal

摘　　要：目的分析慢性乙肝患者血清生化、血常规、血清病毒载量及乙型肝炎标志物与肝组织炎症分级、纤维化分期的相关性,以找到有较好相关性的临床指标;通过肝活检证实临床诊断与病理诊断的符合情况,探讨肝活检的重要性及价值。方法对2007年6月-2009年8月在传染科行肝穿刺活检的359例慢性乙型肝炎患者的血清丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TB)、白蛋白(ALB)、球蛋白(GLB)等指标,白细胞(WBC)、血小板(PLT)等指标,凝血酶原时间(PT),血清HBVDNA定量及乙肝标志物的不同状态与肝穿病理分级、分期的相关性进行分析;统计慢性乙肝患者临床诊断与病理诊断的符合情况。结果肝组织炎症分级及纤维化分期之间有一定相关性(P<0.05);血清ALT、AST、ALB、GLB、PT有助于判断肝组织炎症程度(P<0.05);ALB、GLB、WBC、PLT、PT对肝组织纤维化程度的评估有意义(P<0.05);HBVDNA复制水平与肝组织炎症及纤维化无关(P>0.05),但存在负相关的趋势;纤维化程度高的患者HBeAg阴性组较HBeAg阳性组更多(P<0.05)。慢性乙型肝炎患者临床与病理诊断总符合率为56.3%。结论动态监测慢性乙肝患者肝功能、血常规、凝血常规在一定程度上有助于判断疾病的程度,但要确诊肝组织炎症分级及纤维化分期,肝组织病理活检是必需的。Objective To analyze correlation between hepatic damage or fibrosis and serum biochemical indices, routine blood, quantity of serum HBV DNA and HBV markers in patients with chronic hepatitis B for seeking some better clinical indices. To confirm the difference between clinical diagnosis and pathological diagnosis by means of liver biopsy. Methods From June 2007 to August 2009, 359 liver biopsies of patients with chronic hepatitis B were reviewed pathohistologically. Serum samples for alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TB）, albumin （ALB）, globulin （GLB）, white blood cell （WBC） and platelet （PLT） count, prothrombin time （PT）, quantity of HBV DNA and HBV markers were collected simultaneously half a month before and after the biopsy. The correlations were assessed between hepatic pathohistology and clinical indices. The coincidence was e- valuated between clinical and pathological diagnosis simultaneously. Results The inflammatory staging was significantly related with fibrotic scoring grading （P〉0. 01）. The inflammatory staging was correlated with ALT, AST, ALB, GLB and PT, and fibrotic scoring grading correlated with ALB, GLB, WBC, PLT and PT （P〈0. 05）. The quantity of HBV DNA was irrelevant with inflammatory staging and fibrotic scoring grading （P^0. 05）. The patients with HBeAg negative were more than subjects with HBeAg positive in the level of S4 （P〈0. 05）. The coincidence rate of clinical and pathological diagnosis was 56.3%. Concision Liver function, routine blood and PT are considered to be the valuable reference for clinical diagnosis. However, liver biopsy is indispensable for confirming liver inflammatory staging and fibrotic scoring grading.

关 键 词：慢性乙型肝炎 肝活检 肝功能 血常规 HBV DNA 乙肝标志物 

分 类 号：R512.62[医药卫生—内科学]