ALT<2倍正常上限慢性乙型肝炎病毒感染者肝组织病理学检查分析

On the Examination of Liver Tissue Pathology of ALT<2 ULN Chronic HBV Inflected Persons

目的：探讨ALT〈2倍正常上限慢性乙型肝炎病毒感染者肝组织病理学变化情况及其与肝脏生化、纤维化指标的关系。方法：对102例ALT〈2倍正常上限慢性乙型肝炎病毒感染者，行经皮肝穿刺活体组织检查，判断其肝组织炎症坏死分级和纤维化程度分期，并根据病理分级、分期分别分为G0～1、G2、G3～4组和S0～1、S2、S3—4组，比较各组之间肝脏生化及纤维化指标水平的差异。结果：102例炎症坏死分级≥G2者60例（58．82％），纤维化程度分期≥s2者55例（53．92％）。按照不同炎症坏死分级及纤维化分期，各组肝脏生化指标水平比较，差异无统计学意义（P〉0．05）；纤维化指标Ⅲ型前胶原、透明质酸水平，G0-1和G2组均低于G3～4组，S0～1和S2组均低于S3～4组，差异均有统计学意义（P〈0．05）。结论：肝脏生化指标不能很好反映ALT〈2倍正常上限慢性乙型肝炎病毒感染者肝脏病变严重程度，肝纤维化指标Ⅲ型前胶原、透明质酸有重要参考价值，肝穿刺活检仍是判定肝脏炎症和纤维化程度的金标准。

Objective： To explore the changes of liver tissue pathology of ALT 〈 2 ULN Chronic HBV inflected persons and the relation of the changes, liver biochemistry and fibrosis index. Methods： 102 cases between the two groups of ALT 〈 2 ULN chronic HBV inflected patients were examined of their percutaneous transhepatic puncture biopsy, judge their liver tissue inflammation and necrosis grade and the degree of fibrosis staging. According to pathological grading and staging, the patients were divided into G0- 1 ,G2,G3 -4 group and S0- 1 ,S2 ,S3 - 4 group, and compare the difference of liver biochemistry and fibrosis indexes. Results：Among 102 patients, 60 patients＇ inflammation and necrosis grading≥ G2 （58.82%） ,55 patients＇ degree of fibrosis staging≥S2 （53.92%）. According to the different inflammation and necrosis grading and degree of fibrosis staging, each group＇s liver biochemical indexes level was compared, there were no significant differences （ P 〉 0.05 ） ; PC Ⅲ and HA of G 0 - 1 group and G2 group were lower than （;3 - 4 group, PC In and HA of S0- 1 group and S2 group were lower than S3 - 4 group, there were significant differences （ P 〈 0.05 ）. Conclusion： Liver biochemical indexes cannot reflect the severity of liver disease of ALT 〈 2 ULN Chronic HBV inflected persons, PC Ⅲ and HA had important reference value, needle biopsy of liver is still the best standard to judge inflammation of the liver and the degree of fibrosis.