慢性乙型病毒性肝炎血清学检测与肝活检的对比研究

目的:研究慢性乙型病毒性肝炎患者血清学指标、免疫指标与肝组织活检炎症活动度和纤维化程度的相关性。方法:对90例慢性乙型病毒性肝炎患者进行肝穿刺活检,评估肝组织炎症活动度分级和纤维化分期,并定量检测血清中的ALT及HBV DNA对数级,同时测定ANA抗体及IgG含量。结果:肝组织纤维化程度同炎症活动度呈显著正相关(r=0.589,P<0.01);血清HBV DNA水平与ANA抗体呈正相关(r=0.302,P<0.01),与血清IgG值呈正相关(r=0.404,P<0.01),与纤维化程度以及炎症活动度、肝功异常与否无显著性相关(P>0.05);血清ANA抗体与血清IgG值(r=0.4221,P<0.01)及肝功能受损(r=0.662,P<0.01)呈正相关;血清IgG值与肝功异常两者呈显著正相关(r=0.518,P<0.01)。结论:随着HBV DNA对数级的增加,ANA抗体阳性出现可能性更大,IgG水平亦更高;血清IgG值越高,肝功能受损或抗核抗体阳性几率会增大;本研究未发现合适的血清学指标可作为慢性乙型病毒性肝炎组织病变程度的预测指标,肝穿刺活检依旧为临床准确判断肝组织病理改变程度的金标准。

Comparative Study on Liver Biopsy and Serological Testing of Patients with Chronic Hepatitis B

Objective： To explore the correlations among serological indicators, immune parameters, inflammatory activity level of hepatic tissue biopsy and fibrosis level in patients with chronic hepatitis B. Methods： Ninety patients with chronic hepatitis B were given liver biopsies, the inflammatory activity level and fibrosis level of their liver tissues were observed and assessed. Later, quantitative determination of ALT in serum as well as logarithmical degree ofHBV DNA were analyzed and recorded; meanwhile, ANA and IgG level were also tested. Results： The fibrosis level and inflammatory activity level in the patients＇ hepatic tissues showed significant positive correlation （r=0.589, P〈0.01）. Serum HBV DNA level showed positive correlation with ANA （r=0.302, P〈0.01） and IgG （r=0.404, P〈 0.01）. They showed no obvious correlation with fibrosis level, inflammatory activity level or defected liver fimction （P 〉0.05）. ANA showed positive correlation with IgG level （r=0.4221, P〈 0.01） and liver damage （r=0.662, P〈 0.01 ）. IgG level and defected liver function showed significant positive correlation （r=0.518, P〈 0.01）. Conclusion： As the logarithmical degree of HBV DNA increases, ANA is more likely to be positive. Higher IgG level often leads to higher serum IgG, which follows an increase of liver damages and positive ANA rates. The study did not prove that any serological index can be used as a reliable predictive index to identify the severity of chronic hepatitis B. So far, liver biopsy is still the golden metrics to detect and diagnose pathological changes in liver tissues.