慢性乙型肝炎患者肝脏病理特点与临床关系的研究

目的研究慢性乙型肝炎患者肝脏病理特点与临床非创伤性指标之间的关系。方法收集2006年1月-2008年6月南昌市第九医院住院的临床诊断慢性乙型肝炎患者176例，均行肝活组织检查及病理分期，根据组织学纤维化程度分为非肝硬化组（S0-S3期）、肝硬化组（S4期、活动性肝硬化），了解其构成比；研究非肝硬化组与肝硬化组之间非创伤性指标（包括性别、年龄、乙肝病毒标志物、血常规、生化、凝血系列、HBV—DNA载量、肝纤维化四项、脾脏肋间厚度、HBeAg阳性等25项）的关系。结果①在176例慢性乙型肝炎患者中S0-S3期115例，占65．3％，S4期31例，占17．6％，活动性肝硬化30例，占17．1％。②在非肝硬化与肝硬化2组间，年龄、透明质酸、Ⅲ型前胶原、HBeAg、AAR（AST／ALT）、直接胆红素、白蛋白（ALB）、球蛋白（GL8）、AGR（ALB／GLB）、碱性磷酸酶、γ-谷氨酸转肽酶、红细胞、白细胞、血小板、国际标准化比率、凝血酶原活动度、纤维蛋白原、脾脏肋间厚度差异均有统计学意义（p〈0．05）。③在25项非创伤性指标中，患者的年龄、HA、PCⅢ、HBeAg、AAR、DBil、ALB、CLB、AGR、ACP、GGT、RBC、WBC、RCT、INR、PTA、纤维蛋白原和脾脏肋间厚与肝硬化有显著相关性（P〈0．05）。结论临床诊断慢性乙型肝炎患者中存在一定比例组织学肝硬化患者，临床上有许多非创伤指标有助于判断组织学肝硬化；HBeAg阴性比阳性患者存在组织学肝硬化的可能性大。

Study on Relationship between Liver Pathological and Clinic Characteristics in Patients with Chronic Hepatitis B

Objective To study the relationship between liver histological features and clinic noninvasive parameters in patients with chronic hepatitis B. Methods 176 patients with chronic hepatitis B, who were in hospital during 2006.1--2008.6 in the 9th hospital of Nanchang, were performed liver biopsy and pathological staging and divided into non-cirrhosis group （stages S0-S3） and cirrhosis group（stage S4 and stage active cirrhosis）. The constituent ratio of stages S0-S3, S4 and active cirrhosis was analyzed. The pathological characteristics of cirrhosis were studied by detecting the clinic noninvasive parameters, including sex, age, hepatitis B virus markers, blood routine, biochemical indices, coagulation parameters, HBV-DNA load, four parameters of liver fibrosis, spleen thickness on ribs and HBeAg positive,etc.25. Results （1） Among all patients with chronic hepatitis B, 115 cases （65.3%）were in the fibrosis stages S0-S3,31 cases （17.6%）were in fibrosis stage S4,and 30 cases （17.1% ）were in active cirrhosis stage. （2） There were significant variables,including age,hexadecenoic acid （HA）, precollagen Ⅲ（PC Ⅲ ） ,HbeAg,AAR （AST/ALT） ,direct bilirubin （DBil） ,albumin （ALB）, globulin （GLB）, AGR （ALB/GLB）, alkaline phosphatase （ALP）, glutamate-transpeptidase （GGT）, RBC, WBC, PLT, international normalized ratio （INR）,PTA, profibrin and spleen thickness on ribs, between non-cirrhosis group and cirrhosis group （P〈0.05）. （3） In the 25 non-invasive indicators,there were significant correlation with age, HA, PC Ⅲ , HBeAg, AAR, DBil, ALB, GLB,AGR,ACP, GGT, RBC, WBC, RCT, INR, PTA, profibrin and spleen thickness on ribs of patients and liver cirrhosis （P〈0.05）. Conclusion There were patients with histological cirrhosis in clinical diagnosis of chronic hepatitis B. Many of noninvasive parameters were helpful to diagnosis of histological cirrhosis. Cirrhosis patients with HBeAg-negative were more than those with HBeAg-positive.