儿童乙型病毒性肝炎肝脏病理与肝功能、肝纤维化血清学指标的关系

【目的】探讨儿童慢性乙型病毒性肝炎的肝脏病理变化与肝功能、肝纤维化血清学指标、血清乙肝病毒的脱氧核糖核酸（HBV-DNA）载量的相关性。【方法】回顾性分析2010年7月至2015年6月本院肝病中心收治确诊的79例慢性乙型病毒性肝炎临床病理资料。收集患儿的术前3d的肝功能、肝纤维化血清学四项指标、HBV-DNA病毒栽量等检测指标。根据肝脏病理改变程度分为轻度和中重度炎症损伤两组及无肝纤维化和肝纤维化两组，分析与其血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、总蛋白（Abl）、Ⅲ型胶原蛋白（PCⅢ）、层粘连蛋白（LN）、透明质酸酶（HA）、Ⅳ型胶原蛋白（Ⅳc）水平及HBV-DNA载量的关系。【结果】轻度肝脏炎症组57例，中重度肝脏炎症组22例，两组的ALT、AST、Abl及HBV-DNA载量的差异比较均无统计学意义（P〉0．05）。无肝脏纤维化组19例，肝脏纤维化组60例，两组的肝纤维四项指标发现Ⅲ型胶原蛋白、层粘连蛋白、透明质酸酶及Ⅳ型胶原蛋白差异比较具有统计学意义（P〈0．05），但两组间的谷丙转氨酶、谷草转氨酶、白蛋白、HBV-DNA载量差异无明显统计学意义（P〉0．05）。【结论】肝功能及HBV-DNA载量不能预测儿童慢性乙型病毒性肝炎的肝脏病理炎症改变程度，肝纤维四项对评估患儿肝脏纤维化程度有一定临床意义。肝穿刺活检为评估患儿肝脏病理改变的金标准，对于指导儿童乙型病毒性肝炎的治疗具有重要作用。

Correlation Study of Liver pathology and Liver function and Liver Serum Fibrosis in Children with Chronic Hepatitis B

obj ective]To investigate the correlation between liver pathological changes and liver function,ser-um markers of liver fibrosis and serum HBV DNA (HBV-DNA)in children with chronic hepatitis B (CHB).[Methods]Clinical and pathological data of 79 patients with chronic hepatitis B in our hospital from July 2010 to June 2015 were analyzed retrospectively.The liver function,liver fibrosis serological four indicators,HBV-DNA viral load and other detection indicators of the children 3d before surgery were collected.According to the degree of liver pathological changes,they were divided into two groups,the mild group and the moderate/severe inflamma-tion group,and other two groups as the no liver fibrosis group and liver fibrosis group.Analysis of serum glutamic pyruvic transaminase (ALT),aspartate aminotransferase (AST),total protein (ABL)and type Ⅲ (PCⅢ),lami-nin (LN),hyaluronic acid enzyme (HA),type Ⅳ collagen (Ⅳ C)and the levels of HBV-DNA load were conduc-ted accordingly.[Results]With 57 cases in mild liver inflammation group and 22 cases in moderate/severe liver inflammation group,there were no significant differences in the ALT,AST,Abl and HBV-DNA loads in the two groups (P >0.05).Within 19 cases of no liver fibrosis group and 60 cases of liver fibrosis group,compared statis-tical differences were found in type Ⅲ collagen,laminin,hyaluronic acid enzyme and type Ⅳ collagen in the liver fiber four indexes of the two groups (P <0.05).However,there was no statistical significance between the two groups of alanine aminotransferase,aspartate aminotransferase,albumin and HBV-DNA load (P >0.05).[Con-clusion]Liver function and HBV-DNA load can not predict the degree of liver pathological changes in children with chronic hepatitis B,liver fiber four indexes are able to assess the degree of liver fibrosis in patients with a certain degree of clinical significance.Liver biopsy is the gold standard for evaluating the pathological changes of liver in children,which has an important role in guiding the treatment of children with hepatitis B.