慢性乙型肝炎患者病理特征和临床客观生化指标特点及其相关性分析  

The correlation analysis between the pathological characteristics and clinical biochemical indicators in 468 chronic hepatitis B patients

作　　者：江云[1] 高月求[1] 李曼[1] 张鑫[1] 周振华[1] 

机构地区：[1]上海中医药大学附属曙光医院肝病科,201203

出　　处：《蚌埠医学院学报》2016年第12期1552-1555,1559,共5页Journal of Bengbu Medical College

基　　金：国家自然科学基金(81403237;81473477;81403354;81473629;81403351;81503545);国家"艾滋病和病毒性肝炎等重大传染病防治"科技重大专项(2012ZX10005004-002);上海市青年科技启明星计划(13QA1403500);上海市科委科技支撑项目(13401902900);上海市科委扬帆计划(14YF1411600;15YF1412300);上海市中医药事业发展三年行动计划项目(ZYSNXD-CC-ZDYJ015;ZY3-CCCX-3-3027);上海市卫生局优秀青年人才培养计划(XYQ2013093);中国肝炎防治基金会王宝恩肝纤维化研究基金(CFHPC20131045;CFHPC20131046);上海中医药大学预算内项目(2013JW40;2014YSN39)

摘　　要：目的:探讨慢性乙型肝炎患者(CHB)慢性乙型肝炎患者临床客观生化指标与肝脏组织病理的相关性。方法:收集2013-2015年进行肝脏组织活检的468例CHB患者的基本信息、临床客观生化指标和肝脏组织病理的结果,分析各种临床客观生化指标与肝脏组织病理的相关性。结果:炎症活动度以G2期(70.1%)为主,G4期(1.9%)和G0期(0.0%)最少;纤维化分期以S2期(40.6%)为主,S0期(9.0%)和S4期(4.3%)最少。不同年龄段患者与炎症活动度和纤维化分期均呈正相关关系(P<0.05);随着年龄的增加,肝脏炎症和纤维化程度呈现逐渐加重的趋势。不同lg HBV-DNA与炎症活动度无相关关系(P>0.05),与纤维化分期呈正相关关系(P<0.05)。不同HBs Ag水平和不同HBe Ag水平与病理炎症活动度和纤维化分期均呈负相关关系(P<0.05)。不同炎症活动度患者的丙氨酸氨基转移酶(AST)、白蛋白(ALB)、谷氨酰氨基转移酶(GGT)、凝血酶原时间(PT)间和不同纤维化分期患者的AST和GGT间差异均有统计学意义(P<0.05)。结论:CHB患者的临床客观指标与肝脏组织病理有一定的相关性,患者的临床客观指标在一定程度上反映了肝脏的功能和患者的病情,有助于了解不能行肝组织活检患者的病情和抗病毒治疗的选择。Objective： To explore the correlation between clinical objective biochemical indexes and liver tissue pathology chronic hepatitis B（ CHB）. Methods： The clinical data of liver tissue pathology and objective biochemical indexes in 468 CHB were collected from 2013 to 2015,the correlation of which were analyzed. Results： The inflammatory activity included G2 stage（ 70. 1%,maxium）,G4stage（ 1. 9%） and G0 stage（ 0. 0%,minimum）. Fibrosis stage included S2 stage（ 40. 6%,maxium）,S0 stage（ 9. 0%） and S4 stage（ 4. 3%,minimum）. The inflammatory activity in different age patients was positively correlated with the fibrosis stage（ P〈0. 05）. With the increasing of age,the degree of liver inflammation and fibrosis gradually increased. Different lg10HBV-DNA was not corelated to the inflammatory activity（ P〉0. 05）,and positively correlated with fibrosis stage（ P〈0. 05）. Different levels of HBs Ag and HBe Ag were negatively correlated with the pathological inflammatory activity and fibrosis stage（ P〈0. 05）. The differences of the AST,ALB,GGT and PT between different inflammatory activity patients,and AST and GGT between different fibrosis stage patients were statistically significan（ P〈0. 01）. Conclusions： The clinical objective index in patients with CHB is correlation with the liver tissue pathology to some extent. The clinical objective index of patients can reflect the liver function and illness condition of patients to a certain extent,which can help to understand the condition of patient who cannot accept liver biopsy,and choose the antiviral treatment.

关 键 词：乙型肝炎 组织病理 炎症分级 纤维化分期 

分 类 号：R512.62[医药卫生—内科学]