慢性病毒性肝炎临床与病理诊断的对照研究

目的：通过对慢性病毒性肝炎临床与病理诊断吻合情况的分析,为1995年“病毒性肝炎防治方案（试行）”（简称“1995年方案”）的修订提供初步依据。方法：按“1995年方案”中的病理分度标准,分别为664例慢性病毒性肝炎轻,中,重患者的主要临床症状,体征,实验室参考指标进行比较。结果：慢性病毒性肝乏力,纳差,恶心及腹胀等症状在轻,中,重度慢性肝炎的发生率达51．5％－91．2％,且随病变加重而上升,脾厚,蜘蛛痣等体征与病变关系密切,尤其B超下脾厚在轻,中,重各组发生率分别为25．4％,35．8％及41．1％,且差别非常明显（P＜0．01）,除方案中ALT等6项血液指标外,AST,血小板计数在轻,中,重3组患者也有显著差异。在“1995年方案”血液指标划定范围内,轻度慢性肝炎吻合较好,单项指标吻合率为65．4％－93．6％,中度肝炎6项指标中仅白蛋白／球蛋白1项有53．2％的病人相符,重度肝炎6项指标中仅ALT 1项有30．2％的患者临床诊断与病理相符。结论：对慢性病毒性肝炎的诊断应结合临床症状,体征及实验室多项指标综合判断,新的方案应重视临床症状,脾 脏厚度的意义。并增加AST和血小板计数等实验室指标。

A Comparative study on clinical and pathological diagnosis in patients with chronic viral hepatitis

OBJECTIVE: To provide some suggestions for revision of "1995's program on prevention and treatment of viral hepatitis", a study on the correlation between clinical and pathological diagnosis of chronic hepatitis was performed. METHODS: The main clinical symptoms, signs, and laboratory data taken from 664 patients with mild, moderate and severe chronic viral hepatitis were analyzed and compared with their corresponding pathological findings. RESULTS: The incidence of symptoms such as fatigue, poor appetite, nausea and flatulence was 51.5% to 91.2% in the order of the severity of hepatopathological damage. Splenomegaly and spider nevus showed a close correlation with the degree of pathological changes, especially with the former the incidence being 25.4%, 35.8% and 41.1% among the mild, moderate and severe groups respectively (P < 0.01). In addition to ALT and other five laboratory parameters listed in the program, a remarkable difference of AST and platelet count was also shown in the three groups. There was a better correlation between laboratory results and pathological findings in mild chronic hepatitis, and each one might attain from 65.4% to 93.6%, but this was not so in moderate except for A/G(53.2%) and in severe except for ALT(30.2%) according to the "1995's program on prevention and treatment of viral hepatitis". CONCLUSIONS: A comprehensive judgment for the diagnosis of chronic viral hepatitis should combine clinical symptoms, signs and laboratory results. Great attention should be paid to the significance of clinical symptoms and splenomegaly. AST and platelet count might be included as diagnostic parameters in the new revised program on prevention and treatment of viral hepatitis.