83例肝病患者临床与肝组织病理学分析

The analysis of liver biopsy examination in 83 patients with abnormal liver function tests

目的通过对83例肝病患者的临床与肝组织病理学检查的对比研究,以提高临床诊断的准确性。方法用全自动生化分析仪进行血清生化指标检测,ELISA法检测HBV血清标志物,同时进行肝组织病理检查,检测肝组织HBsAg和HBcAg的表达。结果51例血清HBsAg阳性者肝细胞中均有HBsAg和/或HBcAg表达,32例血清HB-sAg阴性者有9例(28.1%)肝组织中有HBsAg和/或HBcAg表达。75例慢性肝病患者中ALT在各炎症分级组间差异无统计学意义(P>0.05),AST和TBIL在不同的肝脏炎症分级组间差异有统计学意义(P<0.05),且炎症分级越高,AST和TBIL升高越明显;ALT、AST、TBIL值在肝脏纤维化S2期最高。以病理诊断为标准,临床慢性肝炎轻度和中度的诊断准确率分别为61.9%(13/21)和62.5%(20/32),肝硬化的临床诊断准确率为40%。结论以肝组织病理检查为金标准,肝病临床诊断的准确率仍较低。为提高慢性肝病的临床确诊率,应尽可能行肝组织病理学检查。

Objective To study the histological exchanges in liver biopsies in 83 patients with abnormal liver function tests. Methods We used automatic biochemistry to analyse serum ALT,AST and TBil. We also used ELISA to detect HBV serum markers, meanwhile the patients underwent percutaneous liver biopsies to estimate the histopathological injury and hepatic expression of HBsAg and HBcAg by immunohistochemical detection. Results All 51 patients with serum HBsAg positive had positive HBsAg and/or HBcAg expression in liver tissues, and 9 （28.1%）cases expressed HBsAg and/or HBcAg in liver tissues in 32 with serum HBsAg negative. There was no statistical difference between serum AST, ALT, and bilirubin and hepatic activity index in 75 patients with chronic liver disease. According to the pathological diagnosis, the accuracy of clinical diagnosis in mild and moderate chronic hepatitis was 61.9% and 62.5%, and in cirrhosis was 40%, respectively. Conclusions The accuracy of clinical diagnosis in patients with liver disease is low. It＇s necessary to do liver histology examination for relatively correct diagnosis in these patients.