慢性肝炎临床病理诊断的探讨(附617例慢性乙型肝炎临床病理资料分析)

Study on the clinical and pathological diagnosis of chronic hepatitis B

目的 探讨慢性肝炎临床病理分级分期的诊断指标。方法 从 5 80 0例经临床和病理确诊的各型病毒性肝炎及肝病中 ,按临床和病原学诊断排除慢性乙型肝炎重叠感染及其他类型的病毒性肝炎 ,随机抽取近 1 0年来单一 HBV感染的慢性乙型肝炎 61 7例 ,进行组织学分级分期量化分析 ,将慢性肝炎肝组织炎症活动程度分为 1～ 4级 (G1～ 4) ,肝纤维化程度分为 0～ 4期 (S0～ 4)。取肝活检时临床及血生化的主要检测指标对照统计分析。结果 61 7例慢性乙型肝炎中 ,慢性乙型肝炎 (轻度 ) ,G1～ 2 ,S0～ 1 ,2 35例 ,占 38.1 % ;慢性乙型肝炎 (中度 ) ,G2～ 3,S2 ,2 0 0例 ,占 32 .4% ;慢性乙型肝炎 (重度 ) G3,S3,93例 ,占 1 5.1 % ;肝炎肝硬化早期 ,G1～ 4,S4,89例 ,占 1 4 .4%。对照血生化 9项主要指标结合临床分析提示 ,反映蛋白质代谢的四项指标 :即白蛋白 (A) ,球蛋白 (G) ,A/ G,γ- GP对临床分型诊断价值更为可靠 ,其次为 TSB,ALG,AST。结论 慢性肝炎临床病理量化诊断指标简单易行 ,便于临床医师掌握 。

Objective To investigate the diagnosis of clinical and pathological grading and staging of chronic hepatitis B (CHB). Methods Excluded other types of viral hepatitis superinfection, 617 patients with hepatitis B virus only were chosen randomly from 5800 patients with variants hepatitis virus and/or hepatic disease who were diagnosed clinically and pathologically. The pathological changes were analyzed using histological grading and staging, which were classified into 4 grades (1~4 grade) based on histological inflammatory degree and 5 stages (0~4 stage) based on hepatic fibrosis degree. Clinical and blood biochemical indexes served as control. Results Among 617 cases of chronic hepatitis B, mild hepatitis B (G1~2,S0~1) were 235 cases ( 38.1% ), moderate B (G2~3,S2) were 200 cases (32.4%), severe hepatitis B (G3,S3) were 93 cases (15.1%),early liver cirrhosis of hepatitis B (G1~4,S4) were 89 cases (14.4%). It suggested that albumin (A), globulin (G), A/G, γ GP be more dependable for clinical diagnosis by comparing blood biochemical indexes. Conclusions Quantificational clinical pathological diagnosis indexes were simple and accessible for physician to grasp. It was of great value to diagnose hepatitis B.