前白蛋白、胆碱酯酶与胆汁酸对慢性乙型病毒性肝炎病理分级临床价值的研究

目的 明确前白蛋白(PAB)、胆碱酯酶(CHE)及胆汁酸(TBA)判断慢性乙型病毒性肝炎患者肝脏炎症分级及纤维化分期的价值。方法 检测72例经肝活检证实的慢性乙型病毒性肝炎患者血清PAB、CHE及TBA水平,并与肝活检组织炎症分级、纤维化分期进行对照研究。结果 肝脏病理组织炎症分为G1-G4级,纤维化分为S1-S4期。炎症轻重两组间ALT、PAB及CHE有显著性差异(P<0.01),TBA无显著性差异(P>0.05)。随着纤维化程度的加重,ALT变化无规律,PAB、CHE逐渐下降,TBA逐渐升高,且S4与S1、S2、S3比较有显著性差异(P<0.05)。ALT、PAB及CHE与炎症分级均有良好的相关性(P<0.01);CHE、TBA与纤维化分期存在良好的相关性(P<0.01),PAB与纤维化分期存在较弱的相关性(P<0.05)。结论 PAB、CHE较敏感反映慢性乙型病毒性肝炎患者肝脏的炎症程度,三个指标在一定程度上可以提示早期肝硬化。

The study of clinic value of prealbumin,cholinesterase and total bile acid in diagnosing the histologic staging in patients with chronic hepatitis B

Objective To determine the role of prealbumin(PAB) , cholinesterase(CHE) and total bile acid (TBA) in diagnosing the degree of inflammatory and fibrosis of liver in patients with chronic hepatitis B. Methods Serum levels of PAB, CHE and TBA in patients with chronic hepatitis B improved by liver biopsy were detected. Results Serum levels of ALT, PAB and CHE between mild inflammatory group(G1 2) and severe inflammatory group(G3 4) were statistically significant(P <0. 01) ,but TBA of the two group had no difference. With the degree of liver fibrosis increasing, PAB, CHE decreased gradually, TBA increased gradually, the difference between S4 and S1/S2/S3 were statistically significant. ALT, PAB and CHE correlated well with inflammatory grading (P <0. 01) ; CHE and TBA correlated well with fibrosis staging(P <0. 01) , PAB also correlated with fibrosis staging, (P <0. 05). Conclusion PAB, CHE can reflect inflammatory grading sensibly, but TBA cannot. PAB, CHE and TBA can reflect early cirrhosis to some extent.