慢性乙型肝炎患者病理与临床诊断的差异性分析

Discrepancy analysis between clinical diagnosis and pathological diagnosis in patients with chronic hepatitis B

目的探讨慢性乙型肝炎的临床诊断与病理诊断的差异性，寻求更客观的临床诊断标准。方法选择319例慢性乙型肝炎患者进行肝组织穿刺检查及肝组织病理学检查，对临床诊断与病理诊断结果的差异性进行分析。统计学分析采用非参数检验。结果以病理诊断结果为参考，临床诊断轻度、中度、重度及肝硬化的准确率分别为67．3％、37．6％、2．7％和23．5％，其中肝硬化临床诊断漏诊率达93．4％；临床诊断轻度、中度和重度患者与病理诊断纤维化分期符合率较高，分别为75．0％、81.7％和83．8％，肝硬化的f临床诊断与病理纤维化分期符合率较低，为23．5%；在临床诊断或病理诊断中，轻度、中度、重度以及肝硬化组问的ALT、TBil水平并非逐渐增高。结论慢性乙型肝炎的临床诊断与病理诊断存在较大差异；重度肝炎及肝硬化患者临床诊断的准确率较低，对这些患者最好结合肝穿刺组织学检查结果综合考虑，以提高诊断的准确率。

Objective To analyze the discrepancy between clinical diagnosis and pathological diagnosis in patients with chronic hepatitis B （CHB） and explore more objective criteria of clinical diagnosis. Methods Three hundred and nineteen CHB patients received liver biopsy for pathological assessments were investigated retrospectively in this study. The discrepancy between clinical diagnosis and pathological diagnosis was analyzed. The data were compared using nonparametric test. Results Based on the standard of pathological diagnosis, accuracies of clinical diagnosis with mild, moderate, severe CHB and cirrhosis were 67.3~, 37.60/00, 2.7~ and 23.5%, respectively, and the misdiagnose rate of cirrhosis was as high as 93. 4%. Coincidence rates of clinical diagnosis of fibrosis staging in mild, moderate and severe CHB were 75.0%, 81.7% and 83.8% respectively, which were relatively high, but was as low as 23.5% in cirrhosis. Levels of alanine aminotransferase （ALT） and total bilirubin（TBil） were not gradually increasing with stages of mild, moderate, severe and cirrhosis in clinical or pathological diagnosis. Conclusions There are differences between clinical diagnosis and pathological diagnosis. The accuracies of clinical diagnosis are low in patients with severe hepatitis and cirrhosis. It＇s better to make diagnosis based on liver biopsy so that to improve the diagnose accuracy.