76例慢性乙型肝炎病毒携带者肝穿临床指标及病理分析

目的分析慢性HBV携带者血清白蛋白（ALB）、球蛋白（GLB）、HBVDNA定量与肝组织炎症分级、纤维化分期的关系，探讨肝活检的重要性及价值。方法对76例慢性HBV携带者的血清ALB、GLB、HBVDNA定量与肝穿病理分级、分期的关系进行分析；统计慢性HBV携带者临床诊断与病理诊断的符合情况。结果76例慢性HBV携带者中，65例（85．53％）患者均存在不同程度的炎症（G）及纤维化（s）改变，其中G0-1 46例，占60．53％，G2-4 30例，占39．47％；S0-1 56例，占73．68％，S2-20例，占26．32％。ALB水平G0-1明显高于G24（t=7．954，P〈0．01），S0-1明显高于S2-4（t=9．405，P〈0．01）；而GLB水平则相反（t=6．669，P〈0．01；t=2．508，P〈0．05）。HBVDNA不同复制水平与肝组织炎症及纤维化不同分级组间比较差异均无统计学意义（X2=0．034、0．819，P〉0．05）。≥40岁年龄组纤维化程度较重，与〈40岁组比较差异有统计学意义（X2=6．220，P〈0．05）。结论动态监测慢性HBV携带者血清ALB、GLB在一定程度上有助于判断疾病的程度，但要确诊肝组织炎症分级及纤维化分期，肝组织病理活检是必需的。

Evaluation of correlation between liver pathological change and clinical indices in 76 chronic hepatitis B virus carriers

Objective To analyze correlation between hepatic damage or fibrosis and albumin（ALB）, globulin （GLB） and quantity of serum HBV DNA in chronic hepatitis B virus carriers for seeking some better clinical indices. To confnan the difference between chnical diagnosis and pathological diagnosis by means of liver biopsy. Methods From March 2009 to December 2011,76 liver biopsies of chronic hepatitis B virus carriers were reviewed pathohistologically, albumin（ALB） ,globulin（GLB） and quantity of HBV DNA were collected simultaneously half a month before and after the biopsy. The correlations were assessed between hepatic pathohistology and clinical indices. The coincidence was evaluated between clinical and pathological diagnosis simultaneously. Results About 85.52% （65/76） of the patients showed different degrees of inflammation（ G） or fibrosis（S）. For the degree ofinflammation,G0-1 was60.53%（46/76）, and G-z4was 39.47%（30/76）. For the degree of fibrosis, S0-1 was 73.68% （56/76）, and S2-4 was 26.32%（20/76）. The ALB in patients with inflammation level of G0-1 was much higher than C2-4（ t = 7.954, P 〈 0.01）, and in patients with fibrosis level of S0-1 was higher than S2-4（ t = 6.669, P 〈 0.01） ; and the level of GLB were the opposite （ t = 2.649, P 〈 0.01 ; t = 2.508,P 〈 0.05）. The HBV DNA level was irrelevant with inflammatory staging and fibrotie scoring grading（ X2 = 0. 034,0.819, P 〉 0.05）. The degree of fibrosis in the age t〉 40 group was more severe than the age 〈 40 group （X2 = 6.220, P 〈0.05）. Conclusions Serum samples for ALB and GLB are considered to be the valuable reference for chnical diagnosis. However, liver biopsy is indispensable for confirming liver inflammatory staging and fibrotic scoring grading.