肝脏病理检查对转氨酶正常及轻度异常的慢性乙型肝炎患者的临床意义

Clinical significance of pathological examination to patients with chronic hepatitis B having normal or mild abnormal liver transaminases

目的通过分析转氨酶正常及轻度异常的慢性乙型肝炎患者的肝脏病理检查结果,探讨肝活检对这类患者抗病毒治疗的指导意义。方法检查258例患者的血清及肝脏活检病理标本,根据丙氨酸转氨酶(alaninetransaminase,ALT)升高情况,以ALT正常(n=78)和异常(n=180)分组,再以ALT升高<2倍正常上限为界分为ALT≥2倍正常上限组(n=83)和ALT<2倍正常上限组(n=175),分析肝脏病理炎症损伤程度(G)及纤维化分期(S)与检验的符合程度。结果肝功能正常患者中有17例(21.8%)炎症坏死≥G2,27例(34.6%)纤维化≥S2。有33例(42.3%)肝功能正常患者肝穿符合抗病毒指征,有98例(56.0%)ALT<2倍正常上限患者肝穿符合抗病毒指征。以ALT=63.3U/L为界预测炎症坏死≥G2或纤维化≥S2时,曲线下面积为0.781。结论对肝功能正常及轻度异常的慢性乙型肝炎患者,应将肝活检作为判断肝病活动性和是否抗病毒治疗的主要依据。如遇患者无法行肝穿病理检查时,建议医生可考虑将ALT≥63.3U/L作为抗病毒治疗的筛选指标。

Objective Analysis of normal and mild abnormal transaminases in patients with chronic liver biopsy results of liver biopsy for instruction in antiviral therapy. Methods 258 patients were examined in serum and liver biopsy specimens.According to the elevated alanine transaminase（ALT）,the patients were first divided into normal group（n=78） and abnormal group（n=180）,and then againdivided into ALT raise≥twice the upper limit of normal（n=83） and twice the upper limit of normal.Pathological analysis of liver inflammation and injury and fibrosis degree then againdivided into were comparable indicators. Results In those patients with normal liver function,17 cases（21.8%） had inflammation necrosis≥G2,27 cases（34.6%） fibrosis ≥S2.33 cases（42.3%） of liver biopsy in patients with normal liver function proved anti-viral indications,there were 98 cases（56.0%） in ALT 2×upper limit of normal with liver biopsy consistent with anti-viral indications.ALT=63.3 U/L prediction for the critical inflammation and necrosis or fibrosis ≥S2 ≥G2,the area under the curve was 0.781. Conclusion For normal and mild abnormal liver function of chronic hepatitis B patients,liver biopsy should be judged in the liver disease activity and the main basis for antiviral therapy.In case that liver biopsy is unavailable,the suggestion for doctors is ATL≥63.3 U/L as screen indicator for antiviral therapy.