慢性病毒性肝炎临床与病理的相关性研究

目的：研究慢性病毒性肝炎（CH）临床与病理的相关性及CH的临床诊断。方法：对973例CH患者血清生化指标、影像学检查、症状与体征等多种因素与肝组织病理损伤程度进行单因素及多因素判别分析，采用肝功能指数（AAPEA指数）分析血清生化指标在CH诊断中的应用。结果：CH患者凝血酶原活动度（PTA）、血清丙氨酸转氨酶（ALT）、总胆红毒（TBIL）、白蛋白（ALB）、白／球蛋白比值（A／G）、蛋白电泳γ球蛋白（γG）、天冬氨酸转氨酶（AST）、胆碱酯酶（CHE）等生化指标及B超脾脏厚度等，与肝组织病理损伤程度密切相关；AST反映肝脏炎症活动程度优于ALT。多因素判别分析总体误判率为28.1%，但对中、重度误判率较率。肝功能指数（AAPEA）指数与CH肝组织炎症活动程度、纤维化程度及病理分度的相关系数分别为0．559、0．545及0．529（P＜0．0001）。结论：PA、ALT、TBIL、ALB、A／G、γG、CHE、AST等生化指标以及B超脾脏厚度在判定CH程度方面有重要意义。AST反映肝脏炎症活动程度优于ALT。多因素判别分析对CH中、重度误判率较高。AAPEA指数与病理诊断符合率比单项指标判定为高。

Correlation of clinical features with pathology in chronic viral hepatitis

BACKGROUND: To investigate the correlation of clinical features with pathology in chronic viral hepatitis (CH). METHODS: Analyses of single factor and multiple factors of serum biochemical indices, imaging examination results, symptoms and signs with degree of pathological lesion of hepatic tissue in 973 cases of CH were conducted. Meanwhile, the hepatic functional index (AAPEA index) was used to investigate the role of serum biochemical indices in diagnosis of CH. RESULTS: In these patients with CH,the severity of hepatic lesion was closely correlated to symptoms and signs, biochemical indices such as PTA, ALT, TBIL, ALB, A/G, gamma-globulin (gamma-G) by electrophoresis, AST and cholinesterase (CHE) as well as splenic thickness. AST was superior to ALT in reflecting degree of hepatic inflammatory activity. The total mistaken judgment rate of multiple factor analysis was 28.1%. The correlation coefficient of AAPEA index to degrees of hepatic inflammatory activity, fibrosis and pathological grading was 0.559, 0.545 and 0.529, respectively (P<0.000 1) CONCLUSIONS: The biochemical indices such as PTA, ALT, TBIL, ALB, A/G, gammaG, AST, CHE and the determination of splenic thickness by ultrasonography B could reflect hepatic pathological changes to certain extent. AST was superior to ALT in reflecting degree of hepatic inflammatory activity. Incorrect judgment rate was high in determination of moderate and severe CH by multiple factor analysis. Conformity rate between AAPEA index and pathological diagnosis was better than any of them alone in diagnosing CH.