慢性乙型肝炎血生化指标与病理分型的关系探讨

目的 探讨慢性乙肝患者血清生化指标与肝组织病理学炎症及纤维化程度的关系.方法 常规测定197例慢性乙肝患者血清总胆红素(TBL)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、凝血酶原活动度(PTA)、白蛋白/球蛋白比值(A/G),同时行肝穿刺活组织检查,进行组织病理学炎症分级和纤维化分期.分析血清生化指标与肝组织病理改变的相关性.结果 轻度慢性肝炎时,血生化检查单项指标与病理诊断符合率为51.1%～91.3%,尤以ALB符合率较高.重度慢性肝炎以TBIL、ALB、PTA作为标准符合率较高,分别为92.6%,62.9%和59.3%.结论 生化指标检测一定程度上能反映肝脏的炎症和纤维化程度.但单靠血生化指标或肝脏一点穿刺活检确定病情程度有一定误差,应对各项指标综合分析,动态观察.

Study the relationship between serum biochemical indicator and pathological typing in chronic hepatitis B

Objective To investigate the relationship among serum biochemical indicators and liver histopathological inflammation and fibrosis degree in patients with chronic hepatitis B.Methods The serum total bilirubin (TBIL),alanine aminotransferase (ALT),albumin (ALB),prothrombin activity (PTA) and albumin/globulin ratio (A/G) of 197 cases of chronic hepatitis B were detected,and the liver puncture biopsy was performed to get the histopathological grading of inflammation and fibrosis.The relationship between serum biochemical indicators and liver histopathological changes was analyzed.Results With mild chronic hepatitis,the coincidence of single serum biochemical index,ALB particularly,and pathological diagnosis were 51.1%～91.3%;With severe chronic hepatitis,the coincidence of TBIL,ALB and PTA and pathological diagnosis were 92.6%,62.9% and 59.3% respectively.Conclusions The detection of biochemical indicator was to some extent able to reflect liver inflammation and fibrosis to some extent.But there may be some degree of error if only detecting blood biochemieal indicators or liver biopsy.The different detecting indexes should be comprehensive analyzed and dynamic observed.