【摘要】 目的研究慢性乙型病毒性肝炎患者的临床指标与肝脏组织学特点的关系。方法回顾性分析611例行肝穿刺活检的CHB患者的临床资料及肝脏组织病理结果,采用t检验、方差分析、χ2检验等进行统计学分析。结果 611例CHB患者中,ALT、AST、APRI指数与肝脏炎症分级差异具有统计学意义(P<0.05),ALT、AST、APRI指数与肝脏炎症程度分级呈正相关,且不受HBe Ag状态、HBV-DNA水平的影响;在HBe Ag阳性组或HBV-DNA≥20,000IU/ml组中,年龄>35岁者中的G3~4比例均在50%以上(P<0.05)。AST、APRI指数高者肝脏纤维化程度重;年龄>35岁组患者中,S3~4的比例达76.5%(P<0.05)。结论 ALT、AST、APRI指数、年龄可在一定程度上预测肝内组织学特点,使部分患者避免行肝穿术;对于HBe Ag阳性或HBV-DNA≥20000IU/ml的慢性乙型肝炎患者,年龄在35岁以上,肝内组织病理改变已较明显,建议及时启动抗病毒治疗。更多还原

【Abstract】 Objective To study the relationship between clinical parameters and liver histology in patients with chronic hepatitis B(CHB).Methods The clinical parameters and the results of liver pathology of 611 patients with CHB who underwent liver biopsy were analyzed retrospectively.Statistical analysis was performed by using t test,ANOVA analysis,Chi square analysis,etc.Results There was significant correlation of ALT,AST,APRI index and liver inflammation among the 611 patients with CHB(P<0.05).The higher ALT,AST,APRI index,the more severe degree of liver inflammation,which was not affected by the state of HBe Ag or the level of HBV-DNA;In HBe Ag positive group or HBV-DNA≥20,000IU/ml group,the G3~4 ratio of patients older than age 35 was above 50%(P<0.05).The higher AST, APRI index, the more severe degree of liver fibrosis.In patients older than age 35,the proportion of S3~4 reached 76.5%(P<0.05).Conclusion In a sense,ALT,AST,APRI index and age can predict the liver histological features,keeping some patients from liver puncture.If HBe Ag was positive or HBV-DNA was higher than 20000IU/ml,when patients older than age 35,the Intrahepatic histopathological changes have been more obvious,it is recommended to start antiviral therapy in time.更多还原