HIV/HCV共感染者肝穿病理与临床指标

目的 了解HIV/HCV共感染患者肝脏炎症分级及纤维化分期和肝功能检测指标及T淋巴细胞水平之间的关系.方法 选择50例HIV合并HCV感染患者进行肝活检肝脏组织学检测及肝功能 (包括ALT、AST、TBIL、ALB) 及T淋巴细胞水平 (包括CD4、CD8) 的测定, 比较肝功能、T淋巴细胞水平与肝脏炎症分级及纤维化分期的关系.结果 50例HIV/HCV共感染患者中炎症分级G≥2有47例 (94%) 、纤维化分期S≥2有45例 (占90%) 无论肝功能是否正常, 绝大多数患者肝脏炎症及纤维化明显;ALT、AST、TBIL、ALB水平在不同炎症分级和纤维化分期之间无统计学意义 (P<0.05) :肝脏炎症程度ALT、AST异常组较ALT、AST正常组有统计学意义P<0.05:CD4≤200组较CD4>200组在肝纤维化程度、炎症程度方面有统计学意义, P<0.05.结论 肝活检证明HIV/HCV共感染患者绝大多数需要治疗慢性丙肝, ALT、AST、TBIL、ALB水平不能准确反映患者肝损伤水平, CD4≤200 cell/mm3的患者肝脏病理损伤程度更明显.

Correlation between Hepatic Pathohistology of Biopsies and Clinical Indices in Patients with HIV/HCV Co-infection

Objective To investigate the correlation between liver tissue inflammation and fibrosis degrees and CD4+ T-lymphocytes level in the patients with HCV/HIV co-infection. Me thods The relationship between liver biopsy histological inflammatory grade and fibrosis stage, liver function (ALT, AST, TBIL and ALB) , CD4+ T-lymphocytes level of 50 cases HCV/HIV co-infection patients was analyzed. Re s ults There were 47 cases (94%) with liver tissue inflammatory grade G2, and 45 cases (90%) for fibrosis stage S2. Whether liver function was normal or not, most of the patients presented with severe liver tissue inflammatory and fibrosis. There were no distinct differences in serum levels of ALT, AST, TBIL and ALB between inflammatory grade and fibrosis stage (P>0.05) . There were distinct differences on inflammatory grade and fibrosis stage between CD4≤200 cell/mm3 and CD4 ≤200 cell/mm3 group (P <0.05) . Conclus ions Liver biopsy is indispensable for confirming liver inflammatory staging and fibrotic scoring grading. Most of the patients with HCV/HIV co-infection present needing anti-HCV therapy. The CD4+T-lymphocytes level of patients could be a sensitive index for the estimation of the severity of liver damage.