慢性乙型肝炎患者血生化指标和血清病毒标志与肝组织病理的相关性研究

目的探讨慢性乙型肝炎（CHB）患者血生化指标和血清病毒标志与肝组织病理的关系。方法对132例CHB患者行肝穿刺活检，进行组织炎症活动度分级（G）和纤维化程度分期（S），同时检测患者血清总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（y-GT）、总胆汁酸（TBA）、白蛋白（ALB）和血清病毒标记物乙型肝炎病毒e抗原（HBeAg）、乙型肝炎病毒脱氧核糖核酸（HBV—DNA）。结果血清TBIL，ALT、AST、y—GT、TBA平均值随病理分级和分期的增加而逐渐升高，ALB则相反，与肝炎症分级和肝纤维化分期之间有明显相关（P〈0．05）；HBehg的表达与肝炎症分级和肝纤维化分期之间无明显相关（P〉0．05）；HBV—DNA水平与肝炎症变化和纤维化分期无明显相关（P〉0．05）。与病理诊断比较，临床诊断的灵敏度分别为：轻度74．24％（49例），中度60．38％（32例），重度53．85％（7例）。结论血清TBIL、ALT、AST、γ—GT、TBA可反映CHB患者肝组织炎症活动的程度；ALB是慢性乙型肝炎病变进展的指标。血清HBeAg的表达和HBV—DNA水平与肝组织病理炎症分级和纤维化分期之间无明显相关性。仅凭血生化指标、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。

Reserch on the relevance of Biochemical parameters, serological markers of hepatitis B virus and liver tissue pathology in patients with chronic hepatitis

Objective To investigate the chronic hepatit is B （CHB） in patients with biochemical parameters of blood and serum virus markers and liver pathological relationship. Methods 132 patients underwent liver biopsy CHB conduct inflammatory activity grading （G） and fibrosis stage （S）, simultaneous detection of serum total bilirubin （TBIL）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, γ-glutamyl transferase （γ-GT）, total bile acid （TBA）, albumin （ALB） and serum viral markers of hepatitis B virus e antigen （HBeAg）, hepatitis B virus DNA （HBV-DNA）. Resulis Serum TBIL, ALT, AST, GGT, TBA with the pathological grading and staging of the average increases gradually increased, ALB is the opposite, Compared with liver inflammation grade and liver fibrosis stage had significant correlation （P〈0.05）; HBeAg expression on liver inflammation grade and liver fibrosis stage had no significant correlation （P〉0.05）; HBV-DNA levels of liver inflammation grade and liver fibrosis stage had no significant correlation （P〉0.05）. Compared with the pathological diagnosis, clinical diagnosis of sensitivity are as follows： mild 74.24% （49 cases）, moderate 60.38% （32 cases）, severe 53.85% （7 cases）. Conclusion Serum TBIL, ALT, AST, GGT, TBA could reflect the inflammatory activity in patients with liver CHB degree; ALB is the progress of chronic hepatitis B disease indicators. The expression of serum HBehg and HBV-DNA levels and liver pathology and inflammation grade and fibrosis stage was no significant correlation .alone blood biochemical parameters, serum viral replication active liver disease activity to determine whether or not it is not comprehensive, should the liver histological activity of hepatitis as a judge, and whether the main basis for anti-viral therapy.