慢性乙型肝炎的病理与临床

目的：提高慢性乙型肝炎临床诊断的正确性。方法：对202例慢性乙型肝炎患者的临床表现，血液生物化学指标血清总胆红素（TBil)，白蛋白(ALB),凝血酶原活动度（PTA），ALT，白蛋白／球蛋白比值（A／G），r-球蛋白（GGT）]与病理分级分度进行对比分析。结果：临床表现如乏力，纳差，厌油，腹胀，鼻／牙龈出血及肝掌，蜘蛛痣，脾静脉增宽,胆囊炎与肝组织炎症活动密切相关；TBil,ALT,GGT上升及Alb,A/G比值，PTA下降均与肝组织炎症程度加重有关。6项指标中，轻度慢性肝炎临床与病理诊断符合率较高，为63.8%-79.0% ,其次为重度慢性肝炎，为40.0%-62.5%，符合率最低的是中度慢性肝炎，为10.0%-28.2%。结论：临床诊断时要高度重视临床症状，体征的变化，可适当放宽临床分度中有关中度异常值范围。

Pathologic grading and clinical features of chronic hepatitis B

Objective To raise the accuracy of clinical diagnosis of chronic hepatitis B. Methods The correlation between the clinical features, biochemical tests (the serum total bilirubin-TBil, albumin-ALB, prothrobin activity-PTA, alanine aminotransferase-ALT, albumin/globulin-AIG, and r-globulin-r-G) and histopathological data in 202 patients with chronic hepatitis B (CHB) were studied. Results Some of presenting symptoms and signs were obviously associated with histological grade and stage. The grade of necroinflammatory activity of CHB was associated with the rising TB11, ALT, GGT and the declining AIB, A/G and PTA. The coincidence of clinical diagnosis and pathology was highest in mild chronic hepatitis, 63.8%-79.0%; then was in marked chronic hepatitis, 40.0%-62.5%. The coincidence was lowest in moderate chronic hepatitis, l0.0%-28.2%. Conclusions Great attention should be paid to the significance of symptoms and signs, meanwhile the standard of clinical diagnosis for moderate chronic hepatitis might b e relaxed somewhat.