62例慢性HBV携带者肝脏组织学改变与临床的关系

The Study on the Relationship between Liver Histological Changes and the Clinical Data of 62 Patients with Chronic HBV

目的探讨慢性HBV携带者的临床转归。方法对62例慢性HBV携带者进行单人操作肝活检,了解肝脏组织学改变,同时分析临床资料。结果62例慢性HBV携带者中肝组织学有明显病理改变者占91.94%(57/62),其中G1占77.42%(42/62),G2占14.52%(9/62),S0占19.35%(12/62),S1占51.61%(32/62),S2占20.97%(13/62)。肝组织炎症程度的高低与大、小三阳及HBVDNA定量水平无关(P>0.05);肝组织纤维化进展程度与HBVDNA定量水平无关(P>0.05);进展到S2期中以小三阳患者所占比例为多(P<0.01),且外周血肝纤维指标中HA、PⅢ有明显升高(P<0.05);随着纤维化程度的进展,B超脾厚径亦有增大趋势,S2期>S1期>S0期(P>0.05,P<0.01)。结论慢性HBV携带者绝大部分有一定的肝组织学改变,应引起足够重视;肝组织学炎症、纤维化程度改变与乙肝病毒复制水平无关;纤维化程度高者(S2)以小三阳为多,似与病程长短有关;B超脾厚径的检测可早期发现纤维化的存在;定期监测血清HA、PⅢ水平可预测肝组织纤维化的程度。

Objective To discuss the prognosis of chronic HBV carrier.Methods 62patients with chronic HBV were under taken liver biopsy.The hi stological and clinical data were an alysed statistically.Results Patients with obvious histological changes in liver were 91.94%(57/62),of which G1was 77.42%(42/62),G214.52%(9/62),S019.35%(12/62),S151.61%(32/62),and S220.97%(13/62).The grade of liver inflammation(G)was not correlated with the titers of HBeAg and HBVDNA in sera(P>0.05).The stage of liver fibrosis(S)was not correlated with the titers of HBVDNA in sera,either.But most of the patients with HBeAg negative pro gressed to S2of fibrosis(P<0.01),and their serum HA,P Ⅲindex were obviously higher than oth ers(P<0.05).With the progression of liver fibro sis,the width of spleen detected by ultrasonic B was i ncreasing fromS0to S2;S0<S1(P<0.01)<S2(P>0.05).Conclusions Most of the patients with chronic HBV have certain degree of liver histologica l changes.Both the grade of liver inf lammation and the stage of liver fibrosis do not related to HBV replication.Patients wi th HBeAg negative are more likely to h ave more serious liver fibrosis and it seems t o be relative to the period of the deve lopment of the disease.Regular chec k up with ultrasonic B liver scanning can help to diagnose early liver fibrosis and the diagnosis of serum HA and PIII lev el can reflect the degree of liver fibrosis.