慢性乙型肝炎患者血清病毒标志和丙氨酸转氨酶与肝组织病理的相关性

目的 探讨慢性乙型肝炎（CHB）患者血清病毒标志和丙氨酸转氨酶（ALT）与肝组织病理的关系。方法 检测133例CHB患者血清病毒标记物和肝功能，同时全部患者接受彩色B超引导下快速经皮肝穿刺，将患者按HBeAg、HBV-DNA阳性与否各分为4个组．对各组的肝组织炎症和纤维化程度进行比较。结果 所有患者肝组织学显示肝内均有炎症、坏死及不同程度的纤维化存在。血清ALT正常的患者，作肝脏活组织病理检查．仍有一部分肝内有不同程度的炎症及纤维化改变，有的甚至存在肝硬化；ALT异常、HBeAg阴性的CHB患者肝脏炎症和纤维化程度更严重。血清病毒复制的活跃程度与肝组织病理损害的程度不成正比。结论 单凭血清ALT升高、血清病毒复制活跃与否判断肝病活动性是不全面的，应将肝组织病理作为判断肝炎活动性和是否抗病毒治疗的主要依据。

Relation of serological markers of hepatitis B virus and alanine transaminase to hepatic tissue pathology in patients with chronic hepatitis B

Objective To investigate the association of serological markers of hepatitis B virus (HBV) and alanine transaminase (ALT) with hepatic tissue pathology in patients with chronic hepatitis B. Methods The serological marker of HBV, liver function and liver biopsy of 133 patients with chronic hepatitis B were measured and evaluated. The patients were divided into 4 groups according to HBeAg and HBV DNA positivity. Hepatic necrosis/inflammation grade and hepatic fibrosis were compared between the groups. Results Hepatic histological examination of all these patients showed inflammation, necrosis and different degrees of fibrosis. In patients with normal serum ALT, liver biopsy showed different degrees of inflammation, hepatic fibrosis, and even hepatocirrhosis. In patients with abnormal serum ALT negative for HBeAg, hepatic tissue inflammation and fibrosis were more serious. Hepatic tissue pathology was not paralleled with the level of HBV replication. Conclusion Evaluation of the liver disease can not depend solely on serum ALT and viral loading in these patients. Hepatic tissue pathology in patients with chronic hepatitis B should be served as the most reliable evidence for evaluating hepatitis conditions and making the decision on antiviral therapy.