乙型肝炎后肝硬化失代偿期患者的临床病理分析

目的探讨乙型肝炎后肝硬化失代偿期患者的肝脏组织炎症活动度情况,并分析其与血清HBV DNA、HBeAg、临床生化指标的相关性。方法收集乙型肝炎后肝硬化行脾切除术中取肝脏活检的病例82例,取肝组织行HE、网状纤维和Masson染色,观察肝脏组织炎症活动度。以Spearman秩相关分析临床生化指标与肝脏组织炎症活动度的相关性,并采用行*列表资料的χ2检验比较不同血清HBV DNA载量、HBeAg与肝组织炎症活动度关系。结果高达76.8%(63/82)的乙型肝炎后肝硬化失代偿患者肝脏组织仅有轻度活动性炎症(G0-1、G2级);血清ALB与肝组织炎症活动度呈负相关(r=-0.405,P0.01),PT与肝脏组织炎症活动度呈正相关(r=0.340,P0.01),而血清ALT、TBIL、HBeAg阳性、HBV DNA载量和Child-Pugh评分与乙型肝炎后肝硬化失代偿患者的肝脏组织炎症活动度无相关(P0.05)。结论血清HBV DNA载量并不能反映患者的肝脏组织炎症活动度,乙肝病毒持续复制和肝脏炎性反应坏死是肝炎肝硬化病情进展的主要决定因素。无论肝硬化患者体内病毒复制水平如何,均应尽早进行抗病毒治疗。

Clinical and pathological analysis of patients with hepatitis B virus-related decompensated cirrhosis

Objective To investigate the hepatic inflammatory activity in patients with hepatitis B virus-related decompensated cirrhosis, and analyze its correlation with serum HBV DNA loads, as well as HBeAg seropositivity, biochemical parameters. Methods Eighty-two consecutive patients with splenectomy were enrolled. Hepatic inflammatory activity was evaluated by HE staining, reticular fiber staining and Masson staining. Correlation of biochemical parameters with hepatic inflammatory activity was analyzed by Spearman rank. The relationship of different serum HBV DNA loads, HBeAg seropositivity with hepatic inflammatory activity was compared. Results 76.8% of patients had only mild hepatic active inflammation （grade 0-1 or grade 2）. Serum albumin was negatively correlated with hepatic inflammatory activity （r = - 0. 405, P 〈 O. 01 ）, and prothrombin time was positively correlated with hepatic inflammatory activity （r = 0. 340, P 〈 0. O1 ）. While, inflammatory activity was not correlated with serum ALT, TBIL, HBeAg seropositivity, serum HBV DNA loads and Child-Pugh score （P 〉 0.05）. Conclusion HBV DNA load does not reflect hepatic inflammatory activity in patients with hepatitis B virus-related decompensated cirhosis. Hepatitis B viral replication and liver inflammatory reaction are major determinants of cirrhosis with the liver disease progression. Whatever level of virus load in the body of patients with liver cirrhosis, should be for antiviral treatment as soon as possible.