慢性乙肝病毒感染者肝组织学与临床资料的比较

Relationship of Histology and the Laboratory Markers in Subjects with Chronic HBV Infection

目的研究慢性乙型肝炎病毒(HBV)感染者的肝组织学改变与临床资料的关系。方法对259例慢性HBV感染者行肝活检及临床相关检查。分析病理与临床诊断的一致性,按病理诊断携带者、CHB分组以及组织学是否≥G2或≥S2分组,对患者临床资料,包括社会学、生化学、病毒学、纤维化血清学、影像学资料与组织病理学资料比较。结果病理及临床诊断总体一致性欠佳(Kappa=0.273,P<0.01),尤其以携带者的诊断符合率最低(36/144,25%),但在CHB的临床分度方面有较好的符合率(66.7%～86.2%)。分组比较显示:CHB组较携带组饮酒者以及ALT、TBil升高者居多(P分别为0.010、0.001、0.023),HA、PCⅢ、γ球蛋白水平增高(P分别为0.036、0.002、0.032),而HBVDNA水平降低(P=0.010);组织学≥G2或≥S2组较<G2或<S2组年龄大(P<0.001),饮酒者、男性、具家族史者居多(P分别<0.001、0.006、0.026),ALT、TBIL升高及WBC降低者居多(P分别<0.001,0.005、0.023),HA、PCⅢ、γ球蛋白水平增高,脾脏面积增大,而HBV DNA、HBeAg水平降低。ROC曲线分析显示脾面积和PCⅢ的诊断界值分别为25.15cm2、102.45μg/L,敏感度为70.7%、69.8%,特异性为67.9%、71.5%。结论 慢性HBV感染者的组织学与临床诊断总体一致性欠佳,以携带者最显著;脾面积≥25.15cm2或PCⅢ≥102.45μg/L者,应更慎重地全面评估病情,肝组织活检的意义更大,以免延误治疗时机。

Objective To explore the correlation between histology and the laboratory markers in patients infected with chronic hepa- titis B virus. Methods Liver biopsy and related clinical test were investigated for a total of 259 patients with chronic HBV infection. To study the consistence of pathology and clinical diagnosis, patients were divided into different groups according to pathological diagnosis： HBV carriers, CHB degree, and histology degree（ whether 〉 G2 or 〉 S2 ） , and their clinical data such as sociology index, biochemical in- dicator, virology, serum fibrosis index and imaging data were compared. Results The general diagnose accordance rate was poor （Kappa = 0. 273, P 〈 0.01 ） , especially in that of HBV carriers groups （36/144,25%） , but high in that of CHB degree groups （ 66.7% - 86. 2% ）. The percentage of cases who drank was more in CHB degree groups than that in HBV carriers groups, respectively, so was the number of cases with higher ALT or TBil level （ P 〈 0. 001, 0. 023 ）. HA, PC , and the level of 3＇ globulin of cases increased （ P value were O. 036,0. 002,0. 032 respectively） , on the opposite of the level of HBVDNA （ P = O. 010）. The middle age of 〈 G2 group and 〉I G2 group was 23 and 27, respectively （P 〈 O. 001 ）. The number of cases who drank, was female or had family history was more in i〉 G2 group than that in 〈 G2 group（P 〈 0. 001,0. 006,0. 026） , so was the number of cases with higher ALT or TBIL level or lower level of WBC （P 〈 0. 001,0. 005,0. 023 ）. HA, PC 11[ and the level of 3＇ globulin and number of cases with enlarged spleen area increased in 1〉 G2 group than that in 〈 G2 group, on the opposite of HBVDNA level and HBeAg level. The ROC curve analysis showed that the diagnostic cut off of spleen area and PC 11[ was 25. 15cm2 and 102.45ng/ml, with the sensitivity of 70.7% and 69.8% , and the specificity of 67.9% and 71.5% ,respectively. Conclusion The general diagnose accordance rate of patients with chronic HBV infection was poor, especially for that of carriers. Patients with enlarged spleen area （ 〉25.15cm2） or higher level of PCIII （ 1〉 102.45g/L） should be paid more attention in diseases evaluations and results of liver biopsy, in case of timely treatment.