慢性乙型肝炎YMDD变异患者的临床与病理诊断分析

目的探讨慢性乙型肝炎发生YMDD变异时临床诊断与病理诊断的符合性,血清HBV DNA与病理分度的关系。方法对42例YMDD变异的慢性乙型肝炎患者进行测定HBV DNA、肝活检;进行临床诊断与病理诊断对比,作Kappa分析。设37例没有服用拉米夫定无YMDD变异患者为对照组,比较两组间病毒复制情况与病理分度。结果YMDD变异患者临床诊断与病理诊断总符合率为66.7%,慢性乙型肝炎轻度、中度、重度分别为83.3%、40.0%、66.7%,Kappa值=0.346,P<0.01。与对照组比较,肝组织病变程度轻,病理诊断中、重度肝炎少。结论发生YMDD变异时,慢性乙型肝炎病情活动的临床诊断与病理诊断一致性不强,因此,对没有禁忌证的患者应行肝活检,特别是中、重度肝炎患者更应该接受肝活检。慢性乙型病毒性肝炎抗病毒治疗是重要和有效的治疗手段。

Analysis of Clinical and Histopathological Diagnosis in YMDD Mutations of HBV

Objective To assess consistency of the clinical and histopathological diagnosis,and investigate the association of HBV DNA with pathological degree in patients with YMDD mutations of hepatitis B virus(HBV).Methods 42 cases of YMDD mutations of chronic hepatitis B reviewed the content detection of HBV DNA and liver biopsy.The clinical diagnosis with pathological diagnosis was compared.The date about them were analyzed by Kappa test.37 cases with negative YMDD mutations which did not take lamuvidine were control group.We compared pathological degree with hepatic B virus copies between the positive YMDD mutations group and the control group.Results Kappa value=0.346(P<0.01).The general coincidence of clinical and histopathological diagnosis for patients with YMDD mutations is 66.7%.The coincidence of mild,medium,severe hepatitis B were 83.3%,40.0%,66.7% respectively.Comparing with the control group,intrahepatic inflammatory histopathological grading in positive YMDD mutations group was mild,few of which were pathologically diagnosed as medium and severe hepatitis B.Conclusion The weak consistency is observed between the clinical and histopathological diagnosis for patients with YMDD mutations of HBV.So,it is necessary to perform the liver biopsy for patients without contraindication to establish diagnosis and evalue prognosis.Especially,patients with medium or severe hepatitis B in YMDD mutations should perform liver biopsy.It is important and effective for antiviral therapy of chronic hepatitis B.