慢性乙型肝炎的病理与临床诊断

为提高慢性乙型肝炎临床诊断的正确性 ,对 2 0 2例慢性乙型肝炎患者的临床表现、血清总胆红素 (TBil)、白蛋白 (ALB)、凝血酶原活动度 (PTA)、谷丙转氨酶 (ALT)、白蛋白 /球蛋白比值 (A/G)、γ 球蛋白 (γ G)和病理分级分度进行对比分析。结果显示 :临床表现如乏力、食欲缺乏、厌油、腹胀、鼻 /牙龈出血、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、γ G上升及A/G比值、PTA下降均与肝组织炎症程度加重有关。轻度慢性肝炎以ALB和γ G与病理符合率较高 ,分别为 92 .7%和 90 .2 % ;中度慢性肝炎以单一血液学指标为标准与病理符合率较低 ,为 2 .5 %～ 4 5 .0 % ;重度慢性肝炎PTA、ALB、TBil的单项符合率分别为 4 1 .0 %、38.5 %和 2 5 .6 %。若对 6项血液学指标综合判定 ,则轻、中、重度慢性肝炎临床与病理诊断符合率分别达到 95 .9%、77.5 %和 74 .4 %。由此可见 ,临床诊断时要高度重视临床症状和体征的变化 ,同时需结合多种血液指标综合判定。

Comparison of Pathologic Grading and Clinical Features of Chronic Hepatitis B

To raise the accuracy of clinical diagnose on chronic hepatitis B, the correlation between the clinical features, biochemical tests 〔the serum total bilirubin-TBil, albumin(ALB), prothrobin activity(PTA), alanine aminotransferase(ALT), albumin/globulin(A/G), γ-globulin(γ-G)〕 and histopathological data of 202 patients with chronic hepatitis B(CHB)were studied. The Resultes were that some of presenting symptoms and signs were obviously associated with histological grade and stage. The grade of necroinflammatory activity of CHB is associated with the rising of TBIL, ALT, γ-G and the declining of A/G and PTA. The coincidence of clinical diagnose and pathology for ΑLB and γ-G might reach 92.7%, 90.2% in mild chronic hepatitis; the coincidence was lower in moderate chronic hepatitis;the coincidence for PTA,TLB, TBil were 41.0%,38.5%,25.6% in marked chronic hepatitis. However, if the biochemical tests were syntheticlly judged, the coincidence might reach 95.9%, 77.5%, 74.4% in mild, moderate and marked chronic hepatitis. The conclusion might be drawn that great attention should be paid to the significance of symptoms and signs, meanwhile a synthetic judgment biochemical testes is necessary for the diagnosis of CHB.