晚期血吸虫病临床与病理诊断间关系的研究

为探讨晚期血吸虫病（晚血）临床资料和组织学检查之间的关系，本文分析４６例来自疫区的经临床诊断为晚血患者的临床和组织学资料。组织学资料显示，２２例患者（４７．８％）为血吸虫性肝纤维化，合并慢活肝者达１６例（３４．８％），８例（１７．４％）为结节性肝硬变。后二者患者中，肝内ＨＢｓＡｇ阳性率（分别为６２．５％和８７．５％）和谷丙转氨酶（ＧＰＴ）反复异常率（６８．８％和１００％）均高于前者的１８．２％和１８．２％（Ｐ＜０．０５），且病理变化多见碎片状坏死和桥状坏死（可能主要由ＨＢＶ感染所致）。提示目前在疫区临床诊断的晚血患者中，某些患者合并有慢活肝，某些患者本身患的即是结节性肝硬化而被误诊为晚血。因此，对临床诊断为晚血，但具有ＨＢＶ感染标志和谷丙转氨酶反复异常者，应警惕合并慢活肝或结节性肝硬变的可能。重视其鉴别诊断，对于改善晚血的预后具有重要意义。

A RESEARCH ON THE RELATIONSHIP BETWEEN CLINICAL AND HISTOLOGICAL DIAGNOSIS IN LATE STAGE SCHISTOSOMIASIS JAPONICA

To probe the relationship between clinical data and histological examination in late stage schistosomiasis japonica, we analysed the clinical and histological data of forty six patients with late stage schistosomiasis(LSS) diagnosed by clinical data in epidemic area. Histological data showed that 22 cases (47.8%) were diagnosed as hepatic fibrosis induced by schistosomiasis, 16(34.8%) as hepatic fibrosis complicated by chronic active hepatitis(CAH), and 8(17.4%) as nodular cirrhosis. HBsAg positive rate(62.5% and 87.5% respectively) and percentage of fluctuating GPT(68.8% and 100%) of the patients with hepatic fibross complicated by CAH and nodular cirrhosis were higher than that(18.2% and 18.2%) of the patients with hepatic fibrosis( P <0.05), and their histological results showed piecemeal necrosis and bridge necrosis, which may be mainly induced by HBV infection. It is suggested that among the present patients with clinical diagnosis of LSS in epidemic area, some patients were complicated by CAH, and some patients suffered from nodular cirrhosis, but were mistakenly diagnosed as LSS. Therefore, the possibility complicated by CAH, or nodular cirrhosis should be considerable for the patients with clinical diagnosis of LSS who were characterized by positive HBV marker and fluctuating GPT. It is important for improvement of prognosis of LSS to pay attention to differential diagnosis of LSS.