乙肝病毒感染相关性肝硬化临床早期诊断研究  

Clinical Evaluation for Diagnosing Early Liver Cirrhosis in the Patients with Chronic Hepatitis B

作　　者：林小田[1] 侯金林[2] 蔡立莉[1] 武高荣 李敬安 

机构地区：[1]中国人民解放军第422中心医院,广东湛江524005 [2]第一军医大学南方医院

出　　处：《中西医结合肝病杂志》2001年第2期75-77,共3页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨如何对慢性乙型肝炎伴早期肝硬化者进行早期诊断。方法:选取经肝活组织病理检查确诊的80例慢性乙型肝炎伴早期肝硬化(早期LC)者作为研究对象,采集病史及体征,行肝功能和肝纤维化指标以及B超检查,并以同期随机抽取的80例单纯慢性乙型肝炎(CHB)患者作对照。结果:早期LC组患者的临床症状较重,某些体征(如蜘蛛痣、肝掌和肝病面容等)、血清总胆红素(TBil)、白/球蛋白比值(A/G)、凝血酶原活动度(PTA)和γ-球蛋白(γ-G)与CHB组比较均存在显著性差异(P<0.05),而血清丙氨酸转氨酶(ALT)与单纯慢乙肝组比较差异不显著(P>0.05);并且,早期LC组的血清透明质酸(HA)、C3氨基端肽(PⅢP)和板层素(LN)水平显著高于CHB组;此外,早期LC组的B超异常声像图(如肝内光点增粗、分布欠均匀、脾肿大和门静脉增宽等)明显高于CHB组。然而,两组之间HBsAg滴度高低和HBeAg阳性率却无明显差异(P>0.05)。结论:重视体格检查、肝功能化验和血清HA、PⅢP、LN以及B超产像图检查对慢性乙型肝炎合并早期LC的早期诊断具有较大的参考价值。Objective: To evaluate the clinical diagnosis markers of the chronic hepatitis B with early liver cirrhosis (LC). Methods: The clinical feathersi biochemical tests, fibrosis level and B-mode ultrasound of 80 patients with chronic hepatitis B and LC and 80 patients with chronic hepatits B (CHB) diagnosed by histopathological data were analysed. Results: The major presenting symptoms and signs, parameters of biochemical tests such as the serum total bilirubin (TBil), albumin (A), albumin/globulin (A/G) and γ-globulin (γ-G), parameters of fibrosis level such as hyaluronic acid (HA) ,N-termial propeptide of Type Ⅲ (P Ⅲ P) and lamine were very high in the patients with LC than in the chronic hepatitis B (P<0. 05); and the serum alanine aminotransferase (ALT) and total bile acid (TBA) did not reliably reflect the presence of LC; but the width of spleen, intensity of hepatic echo and blood of the liver were closely related to LC in B-mode utrasound. Conclusion: Clinical feather, liver tests, HA, P 333333 P, LN and B-mode ultrasound are useful markers for diagnosing the patient with chronic heatitis B with early LC.

关 键 词：乙型肝炎 早期肝硬化 肝功能试验 病理学 诊断 

分 类 号：R575.2[医药卫生—消化系统]