【摘要】 目的研究慢性乙型肝炎病毒(HBV)感染者的肝组织学改变与临床资料的关系。方法对259例慢性HBV感染者行肝活检及临床相关检查。分析病理与临床诊断的一致性,按病理诊断携带者、CHB分组以及组织学是否≥G2或≥S2分组,对患者临床资料,包括社会学、生化学、病毒学、纤维化血清学、影像学资料与组织病理学资料比较。结果病理及临床诊断总体一致性欠佳(Kappa=0.273,P<0.01),尤其以携带者的诊断符合率最低(36/144,25%),但在CHB的临床分度方面有较好的符合率(66.7%～86.2%)。分组比较显示:CHB组较携带组饮酒者以及ALT、TBil升高者居多(P分别为0.010、0.001、0.023),HA、PCⅢ、γ球蛋白水平增高(P分别为0.036、0.002、0.032),而HBVDNA水平降低(P=0.010);组织学≥G2或≥S2组较<G2或<S2组年龄大(P<0.001),饮酒者、男性、具家族史者居多(P分别<0.001、0.006、0.026),ALT、TBIL升高及WBC降低者居多(P分别<0.001,0.005、0.023),HA、PCⅢ、γ球蛋白水平增高,脾脏面积增大,而HBV DNA、HBeAg水平降低。ROC曲线分析显示脾面积和PCⅢ的诊断界值分别为25.15cm2、102.45μg/L,敏感度为70.7%、69.8%,特异性为67.9%、71.5%。结论 慢性HBV感染者的组织学与临床诊断总体一致性欠佳,以携带者最显著;脾面积≥25.15cm2或PCⅢ≥102.45μg/L者,应更慎重地全面评估病情,肝组织活检的意义更大,以免延误治疗时机。更多还原

【Abstract】 Objective To explore the correlation between histology and the laboratory markers in patients infected with chronic hepatitis B virus.Methods Liver biopsy and related clinical test were investigated for a total of 259 patients with chronic HBV infection.To study the consistence of pathology and clinical diagnosis,patients were divided into different groups according to pathological diagnosis: HBV carriers,CHB degree,and histology degree(whether ≥G2 or ≥S2),and their clinical data such as sociology index,biochemical indicator,virology,serum fibrosis index and imaging data were compared.Results The general diagnose accordance rate was poor(Kappa=0.273,P<0.01),especially in that of HBV carriers groups(36/144,25%),but high in that of CHB degree groups(66.7%-86.2%).The percentage of cases who drank was more in CHB degree groups than that in HBV carriers groups,respectively,so was the number of cases with higher ALT or TBil level(P<0.001,0.023).HA,PCⅢ,and the level of γ globulin of cases increased(P value were 0.036,0.002,0.032 respectively),on the opposite of the level of HBVDNA(P=0.010).The middle age of <G2 group and ≥G2 group was 23 and 27,respectively(P<0.001).The number of cases who drank,was female or had family history was more in ≥G2 group than that in <G2 group(P<0.001,0.006,0.026),so was the number of cases with higher ALT or TBIL level or lower level of WBC(P<0.001,0.005,0.023).HA,PCⅢ and the level of γ globulin and number of cases with enlarged spleen area increased in ≥G2 group than that in <G2 group,on the opposite of HBVDNA level and HBeAg level.The ROC curve analysis showed that the diagnostic cut off of spleen area and PCⅢ was 25.15cm2 and 102.45ng/ml,with the sensitivity of 70.7% and 69.8%,and the specificity of 67.9% and 71.5%,respectively.Conclusion The general diagnose accordance rate of patients with chronic HBV infection was poor,especially for that of carriers.Patients with enlarged spleen area(≥25.15cm2) or higher level of PCⅢ(≥102.45μg/L) should be paid more attention in diseases evaluations and results of liver biopsy,in case of timely treatment.更多还原