乙肝病毒感染对慢性乙肝肝硬化患者胃黏膜病变的影响

目的探讨乙肝病毒(HBV)感染对慢性乙肝、肝硬化患者胃黏膜病变的影响及其发病机制。方法2003-06～2004-02对河北医科大学第三医院感染科60例慢性乙肝、肝硬化患者同时行肝穿、胃镜、肝功能、血清肝炎病毒标志物检查,采用SP法检测肝及胃黏膜组织中HBsAg、HBcAg。结果(1)肝组织病理损害程度与胃黏膜病变程度成正比(r=0.483,P<0.01)。(2)56例中26例胃黏膜组织中可检测到HBsAg和(或)HBcAg,其病变以中重度为主。34例HBVM阴性患者中,病变以轻中度为主(P<0.01)。(3)肝组织与胃黏膜组织中HBsAg同时阳性17例;HBcAg同时阳性6例(P>0.05)。(4)血清及胃黏膜组织中HBsAg和(或)HBcAg同时阳性26例;HBVDNA同时阳性22例(P>0.05)。结论进一步证实了HBV可侵犯胃黏膜组织,并在其中复制,是导致慢性乙肝患者胃黏膜病变的重要因素。胃黏膜病变程度与胃黏膜组织HBV感染、肝组织病变程度密切相关;与血清及肝组织中HBV分布无关。

Influence of HBV infection for gastro mucous membrane in chronic hepatitis B and cirrhosis

Objective To study the influence of HBV infection for gastromucous membrane in chronic hepatitis B and cirrhosis and its pathogenesis.Methods The liver biopsy,gastroscope,liver function and HBVM were detected at the same time in 60 patients with chronic hepatitis B and cirrhosis.HBsAg and HBcAg in the tissues of liver and gastromucous membrane were detected by SP immunohistochemistry.Results The damage of gastromucous membrane were found in 56 of 60 patients.Its damage degree was showed as moderate and severe.The other 34 showed mild and moderate damage(P<0.01).There were a close direct correlation between the damage degree of gastro mucous membrane and liver tissues.The HBsAg and HBcAg in the liver tissues had no correlativity with the positive findings of HBsAg and HBcAg in the gastromucous membrane(r_1=0.008,P_1=0.950,r_2=0.238,P_2=0.063).HBVM in the gastromucous membrane was not correlative compared with the HBVM types in the serum and the level of HBV DNA( r_1=0.217,P_1=0.095,r_2=0.085,P_2=0.505).Conclusion The incidence of pathological changes of the gastromucous membrane in the patients with CHB and cirrhosis is high.The pathological degree of gastromucous membrane in the patients with CHB has positive correlation with the pathological degree of the liver tissue.The pathological degree of the gastro mucous membrane in the patients with positive HBVM is serious.The pathological degree of gastromucous membrane in CHB and cirrhosis has no correlation with the HBVM in the serum,the level of HBV DNA and HBVM in the liver tissue.