乙型肝炎289例的肝组织病理学特征与预后关系的随访观察

Follow-up observation on the relationship between hepatic histopathological character and prognosis in 289 patients with hepatitis B

目的探讨乙型肝炎病理学特征与预后的关系。方法就289例乙型肝炎肝组织病理学特征与预后关系作了临床、肝活检随访观察。结果在146例肝组织学显示急性轻型肝炎，2例因并发症死亡，其余皆获得治愈，随访1a～2a无复发者。急性重型肝炎（ASH）预后不良，亚急性重型肝炎（SSH）治疗成功率也较低。在慢性肝炎（CHB）的G1G2组，痊愈占32％，病变稳定占36％，仅少数肝病变加重。在CHB的G3G4组，肝病变加重和无变化占48％，3例肝细胞异型增生者转变为肝细胞癌（HCC）。随访肝活检提示，分级病变修复较快，好转者随时间的延长而增多，间隔3mo-5mo与la-2a差异显著（P〈0．05），而纤维组织降解延迟，随时间延长有缓慢增加之势（P〈0．01）；纤维带宽、量多伴弹力纤维增生显著者，易转变为肝硬变，故其是治疗的重点和难点。结论肝组织病理学特征是制订治疗方案、预测预后的可靠标准。

Purpose To study the relationship between pathologic character and prognosis in the hepatitis B. Methods On relationship between hepatic tissues pathologic character and prognosis, 289 patients with hepatitis B were carded on follow-up observation in the clinical and liver biopsies. Results Hepatic histological examinations show acute slight hepatitis in 146 patients, 2 patients died because of complications; the rest were soon cured in 144 patients and no relapse in the follow-up la-2a. All the acute serious hepatitis were dead and sub-acute serious hepatitis therapy success were low. In the chronic hepatitis B （CHB） of G1G2 groups, patients recovery was 32% and liver lesion stable was 36%; and only a few patients condition worsened. In the CHB serious groups （G3G4）, the patient＇s condition worsened or no changes was 48% and transformation of HCC in 3 patients with hepatocytes atypical hyperplasia. Follow-up of liver biopsies histology show that grading lesion swift recovered one＇s health and increase improving with elongation time. Hepatic biopsy interval 3mo-Smo and la-2a were significant difference （P〈0.05）. But the fibrotic tissues degradation was delayed and there were making slow increment along with elongation time （P〈0.01）. The fibrotic zones breadth and multi-quantity or accompany elastic fibers striking proliferation were to exchange conversion cirrhosis. Therefore, G3G4 were therapeutic focal point and difficult. Conclusions Liver histopathologic character is reliable to work out therapeutics program and predict prognosis.