慢性乙型肝炎肝纤维化与肝功能 病毒定量的关系探讨

Approaching of the Reference of Chronic Hepatitis B Fibrosis with Liver Function and Virus Quantitative

目的：探讨慢性乙型肝炎肝纤维化与肝功能、病毒定量之间的关系，为临床预测疾病的严重程度提供依据。方法：采用临床病例观察及实验室检测，收集2004年5月-2005年11月广东省中医院肝病门诊及住院的152例确诊慢性乙型肝炎肝炎纤维化患者的临床资料，包括病史、症状、辨证分型、辅助检查（如ALT、AST、HBV-DNA、肝纤四项）等数据，应用SPSS13．0软件包建立数据库，进行统计分析。结果：Cl-Ⅳ值在肝功能不同损害程度的组别间比较，差异有统计学意义（P〈0．05），但PCⅢ、LN、HA3项指标在肝功能损害程度不同的组别间比较，差异均无统计学意义（P〉0．05）。ALT、AST与肝纤四项的相关性分析提示ALT、AST与Cl-Ⅳ水平存在低度相关，而与PCⅢ、LN、HA水平无相关关系。Cl-Ⅳ、LN、HA值在HBV-DNA不同复制程度的组间两两比较，经统计学处理，差异均无统计学意义（P〉0．05）；但PCⅢ值中的HBV-DNA中度复制组（10^6-10^7copies／mL）与HBV-DNA正常组（〈1．03copies／mL）相比，差异有统计学意义（P〈0．05），结合HBV-DNA定量与肝纤四项的相关性分析，提示并不能认为血清中的HBV-DNA定量与肝纤四项有相关性（P〉0．05）。结论：肝功能与HBV-DNA定量能在一定程度上反映肝脏的炎症活动，但并不能直接反映肝脏纤维化的程度，因此，并不能因为肝功能正常或HBV-DNA复制不活跃就否认肝纤维化的存在，同时也不能因为肝功能异常或HBV-DNA复制活跃就认为肝纤维化一定存在。

Objective： To research the reference of Chronic hepatitis B fibrosis with liver function and rivus quantitation, and provide the evidence for clinic to estimate the disease severity degree. Methods ： Adopt the method of observing cases and laboratory detect. The cases were 152 altogether who were from clinic and in - patient department in May 2004 to Nov. 2005. And they were diagnosed as chronic hepatitis B and liver fibrosis. Write down the detail information including the medical record, symptoms, syndrome type, and the laboratory results as ALT, AST, HBV- DNA, and PCⅢ, Cl - Ⅳ, LN, HA, etc. And then, collect all the information and make a database, and make the iesult by SPSS13.0 software. Results： In the relationship of liver function, Cl -Ⅳ is significant difference in different liver fimcfion groups （P 〈 0. 05 ）. But PC Ⅲ, LN, HA were no significant difference in groups of different liver function （ P 〉 0. 05 ）. In correlation analysis, ALT and AST had low correlation with Cl - Ⅳ, and no correlation with PCⅢ, LN and HA. About the relationship of replication of HBV - DNA and the four liver fibrosis targets, there is no obvious difference in Cl - Ⅳ, LN, HA when different quantitative HBV - DNA groups. In PCⅢ, there is obvious difference in the middle replicate group and the normal group（ P 〈0.05 ）. The correlation analysis of quantitative HBV - DNA and the four liver - fibrosis target showed no correlation in quantitative HBV - DNA and liver - fibrosis target （ P 〉 0. 05 ）. Conclusions： Liver function and replication of HBV - DNA are the two targets which reflect the inflammation of liver, and they reflect the liver inflammation in a way, but they cant reflect liver fibrosis, so, we cant consider there is no liver fibrosis because of the normal liver function or low replicate of HBV - DNA, in the same way, we cant consider that liver fibrosis is occurring when we see the abnormal liver function or high replicate of HBV - DNA.