慢性乙型肝炎的病理及临床诊断分析

Pathological and clinical diagnosis analysis of chronic hepatitis B

目的探讨慢性乙型肝炎的病理诊断和临床诊断情况。方法选取本院经临床诊断为慢性乙型肝炎的患者240例，根据其病变程度进行分型．将其与病理学检验结果进行对比，探讨两种方法的诊断价值。结果慢性乙型肝炎病理活检轻度79例，中度106例，重度33例，早期肝硬化22例，与临床诊断结果差异有统计学意义（P〈0．05）；临床诊断与病理诊断慢性乙型肝炎轻度（G1～2，S0～2）符合率为49．38％，中度（G3，S3）符合率为53．33％，重度（G4，S4）符合率为50．00％，早期肝硬化符合率为80．00％，符合率较低。慢性乙型肝炎病理免疫诊断HBsAg、HBcAg阳性率较临床诊断阳性率高，差异有统计学意义（P〈0．01）。结论慢性乙型肝炎临床诊断不能作为诊断“金标准”，为明确诊断、早期诊治，推荐应用肝穿刺活检进行病理诊断。

Objective To explore the similarities and differences of chronic hepatitis B in both pathological and clinical diagnoses.Methods 240 cases clinically diagnosed as chronic hepatitis B in our hospital were selected,and were classified based on degrees of pathological changes and compared by pathological inspection results in order to explore the diagnostic values of the two methods.Results By biopsy,the number of the chronic hepatitis B in mild,moderate,se- vere and early stage of liver cirrhosis cases was 79,106,33,and 22 cases respectively,which displayed significant differences compared to the results by clinical diagnosis.The coincidence rates of chronic hepatitis B diagnosed both clini- cally and pathologically in mild （G1-2,S0-2）,moderate （G3,S3）,severe （G4,S4）,and early liver cirrhosis conditions was 49.38%,53.33%,50.00%,and 80.00% in turn,which indicated the lower concidence rate.There was statistical difference in HBsAg and HBcAg positive rates by clinical and pathological diagnoses in chronic hepatitis B,and the positive rate diagnosed pathologically was higher （P〈0.01）.Conclusion The clinical diagnosis of chronic hepatitis B can not be se- lected as golden standard in its diagnosis.It is recommended to adopt liver biopsy for pathological diagnosis for definite diagnosis and early treatment.