慢性乙型肝炎患者肝组织病理阅片结果主观差异研究

Effects of subjective differences on liver tissue pathology reading of chronic hepatitis B patients

目的通过分析不同阅片者对同一慢性乙型肝炎（CHB）患者肝组织病理切片结果诊断的主观性误差对比以了解肝组织病理这一金标准的可信程度。方法收集125例CHB患者肝组织活检术后病理切片（嗜银染色、HE染色、免疫组化）及病理学资料（炎症分级G、纤维化分期S、免疫组化HBcAg分布）。将病理切片交由另一位资深肝脏病理学家进行再次单盲阅片，统计阅片结果并与本院病理资料进行对比。结果收集两次阅片G分级123例，G0～4分级一致率分别为G016.67%、G125.8%、G221.05%、G353.85%、G425%，S分期125例，S0～4分期一致率分别为S072.7%、S117.4%、S265.5%、S354.84%、S445.16%，HBcAg不同分布117例，HBcAg分布呈阴性、浆型、核型、混合型的前后阅片一致率分别为77.42%、42.1%、75%、6.78%；对两次阅片G分期、S分期、HBcAg分布结果进行统计学分析，χ2=58.352、15.451、68.238；P=0.000、0.004、0.000。结论不同病理专家对相同的CHB患者肝组织病理切片的阅片结果存在较明显主观差异，尤其在判定G2/G3、S1/S2中。故临床应用肝脏病理结果这一“金标准”时仍需结合其他资料进行综合判断。

Objective To assess the credibility of liver biopsy which is considered to be a gold standard for ifbrosis evaluation. Methods The pathological sections （silver staining, HE staining, immunohistochemistry） of 125 patients with chronic hepatitis B were collected. These sections were single-blind read by the other pathologist. All results were compared and analyzed. Results Total of 123 pathological sections of different hepatic histological inlfammation （G） were collected, with coincidence rates of G0 to G4 are 16.67%, 25.80%, 21.05%, 53.85% and 25.00%, respectively, there’s significant difference （χ2= 58.352, P = 0.000）; 125 pathological sections of different liver ifbrosis （S） stages were collected, and coincidence rates of S0 to S4 were 72.70%, 17.40%, 65.50%, 54.84%and 45.16%, respectively, with signiifcant difference （χ2=15.451, P=0.004）;117 pathological sections of different distribution types of HBcAg were collected, coincidence rates of HBcAg negative, cytoplasm distribution, nuclei distribution and mixed type distribution were 77.42%, 42.10%, 75.00%and 6.78%, respectively, with signiifcant difference （χ2=68.238, P=0.000）. Conclusions There’s signiifcant differences among the results given by different pathological professors viewing the same liver biopsy from patients with chronic hepatitis B, especially in assessing liver biopsy of G2 or G3 and S1 or S2. Thc assessment of liver biopsy should be made in combination with other clinical data.