慢性乙型肝炎血清病毒标志及转氨酶与肝脏病理关系探讨

Study on the corretation between serum HBV.M,alanine transaminase and hepatic tissue pathology in patients with chronic hepatitis B

目的探讨慢性乙型肝炎(CHB)患者血清病毒标志与ALT及肝脏病理的关系。方法检测133例CHB患者血清病毒标记物和肝功能,同时全部患者接受彩色B超引导下快速经皮肝穿刺,将患者按HBeAg、HBV-DNA阳性与否及ALT正常与否分为8个组,对各组肝组织炎症和纤维化程度进行比较。结果所有患者肝组织学显示肝内均有炎症、坏死及不同程度的纤维化存在,血清转氨酶正常的患者仍有一部分肝内有不同程度的炎症及纤维化改变,有的甚至存在肝硬化;ALT异常、HBeAg阴性的慢性乙型肝炎患者肝脏炎症和纤维化程度更严重。血清病毒复制的活跃程度与肝组织病理损害程度不成正比。结论单凭血清转氨酶的升高、血清病毒复制活跃与否判断疾病活动性是不够的,在临床选择抗病毒治疗的适应证时,肝活检对此有不可取代的价值,应将肝活检作为判断肝炎活动性和是否需要抗病毒治疗的主要依据。

Objective To investigate the relationship between serum HBV. M. alanine transaminase（ALT） and hepatic tissue pathology in patients with chronic hepatitis B. Methods The serum HBV. M. liver function in 133 patients with chronic hepatitis B were measured, and these patients underwent： percutaneous liver biopsy by colour Echo. All these patients were divided into eight groups according to HBeAg and HBV DNA positive or negative,ALT normal or not. Hepatic necrosis inflammation grade and hepatic fibrosis stage in the groups were compared. Results Hepatic histology of all these patients showed inflammation and necrosis and different degree fibrosis. In serum ALT normal patients, liver biopsy still showed different degrees inflammation and hepatic fibrosis degrees partly, even showed hepatocirrhosis. In serum ALT abnormal and HBeAg negative patients with chronic hepatitis B patients, hepatic tissue inflammation and fibrosis degrees were more serious, hepatic tissue pathology was out of proportion to the degree of serum HBV reproduction. Conclusion Judgment of disease activity doesn＇t only depend on the serum transaminases and the degree of serum HBV DNA replication. When clinical choosing indication of antiviral therapy, value of liver biopsy should notbe substituted. Liver biopsy in chronic hepatitis B should be regarded as main basis of judgment the hepatitis activity. It also should be regarded as main basis if antiviral therapy is conducted.