慢性重型肝炎患者离体肝组织病理与临床诊断的相关性

目的 研究慢性重型肝炎患者的病理诊断与临床诊断的符合率,筛选与病理诊断符合率高的临床诊断指标.方法 选取2004年11月-2009年6月于北京佑安医院住院并进行肝移植的病例,筛选出临床诊断为慢性乙型重型肝炎和(或)病理诊断为慢性乙型重型肝炎的病例为研究对象.检测患者白细胞、血小板、平均红细胞体积、总胆红素、直接胆红素、白蛋白、ALT、AST、尿素氮、肌酐、血糖、胆碱酯酶、总胆固醇、γ-谷氨酰转移酶、碱性磷酸酶、血清钾、血清钠、凝血酶原活动度及血氨水平,彩色超声检查测量门静脉宽度及脾静脉厚度,并对其在不同组别患者间的差别进行比较.2组间数据比较用独立样本t检验,3组间数据比较用F检验.结果 51例患者中,临床及病理诊断符合率64.7%.慢性重型肝炎组ALT及AST分别为(675.0±510.0)U/L和(392.0±370.0)U/L,均高于活动性肝硬化组的(67.0±45.0)U/L和(103.0±59.0)U/L(t值分别为2.349和2.332,P值均＜0.01);慢性重型肝炎组中发病时间＜30d者的ALT为(761.0±743.0)U/L,明显高于发病时间≥30d者的(117.0±112.0)U/L(t=2.928,P＜0.01);慢性重型肝炎组和活动性肝硬化组的酶-胆分离现象发生率分别为78.9%及0.结论 慢性乙型重型肝炎的临床与病理诊断符合率不高,观察ALT和AST升高幅度及疾病过程中有无酶-胆分离现象有助于提高慢性重型肝炎的诊断符合率.

Correlation research of isolated liver tissue pathology and clinical diagnosis in patients with chronic severe hepatitis B

Objective To study the coincidence rate of clinical diagonisis with pathological diagnosis for chronic severe hepatitis, and to screen out clinical indicators consistent with pathological diagnosis.Methods Fifty-one patients diagnosed as chronic severe hepatitis and underwent liver transplantation in Beijing You'an hospital from November 2004 to June 2009 participated in this study. The clinical data were selected as following: ALT, AST, urea nitrogen, creatininc, glucose, cholinesterase, total cholesterol, Glutamyl endopeptidase, alkaline phosphatase, serum potassium, serum sodium, prothrombin activity and blood ammonia level. The width of the portal vein and splenic vein thickness were measured by color Doppler ultrasound and were compared in different groups. Data were ananlyzed with independent sample t test and F test. Results The coincidence rate between clinical and pathological diagnoses in this study was 64.7%. ALT and AST levels for Chronic severe hepatitis and decompensated cirrhosis were 675.0 ± 510.0 U/L, 67.00 ± 45.0 U/L ( P ＜ 0.01) and 392.0 ±370.0 U/L, 103.0 ± 59.0 U/L(P ＜ 0.01) respectively, with statistically significant difference existed. The mean level of ALT in Chronic severe hepatitis group was significantly different in the situations of onset less than 30 days or more than 30 days (means were 761.0 ± 743.0 U/L and 117.0 ± 112.0 U/L,P ＜ 0.01). The rate of the phenomenon of enzyme isolated bile in the chronic severe hepatitis and decompensated cirrhosis group were 78.9% and 0 respectively. Conclusions The coincidence rate of clinical with pathological diagnoses for Chronic Severe Hepatitis was low, increased ALT and AST levels would help improve the diagnostic accuracy.