慢性乙型肝炎患者红细胞分布宽度与肝纤维化及炎症分期的相关性分析

Study on correlation among distribution of width of red cells,liver fibrosis and necrosis in patients with hepatitis B

目的：探讨慢性乙型肝炎患者红细胞分布宽度（ RDW）与肝纤维化和炎症分期的相关性及其临床意义。方法选取确诊为慢性乙型肝炎的患者175例，检测血常规、生化指标和乙肝病毒学参数，并采用肝穿刺活检确定患者的纤维化和炎症分期，以单因素、多因素分析评价不同指标与肝脏纤维化、炎症分期的相关性。结果175例患者均顺利完成肝组织病理学检查，无一例出现严重不良反应；纤维化分期结果 S0～ S2占98例（56.0%），S3～ S4占77例（44.0%）；炎症分期 G0～ G2占87例（49.7%），G3～ G4占88例（50.3%）；S3～ S4期患者的年龄、AST、白蛋白、总胆红素、血小板、MPV 和 RDW 高于 S0～ S2期（ P ﹤0.05）；G3～ G4期患者 ALT、AST、白蛋白、总胆红素、血小板、MPV 和 RDW 高于 G0～ G2期（ P ﹤0.05）；多因素 Logistic 回归分析表明，年龄、AST、白蛋白、总胆红素、血小板、MPV 和 RDW 与纤维化分期相关（ P ﹤0.05），而 ALT、AST、白蛋白、总胆红素、血小板、MCV、MPV、RDW 与炎症分期相关（ P ﹤0.05），其中 RDW 的 OR 值均为最高。结论 RDW 是一种新颖、高效的肝病诊断指标，能为肝纤维化和肝细胞炎症提供诊断信息，减少肝细胞活检的需要。

Objectine To explore the relationship among distribution of red blood cell width（RDW）,liver fibrosis and inflammation sta-ges in patients with chronic hepatitis B. Methods A total of 175 patients with chronic hepatitis B in this hospital during August 2010 to December 2014 were allocated for this study. Blood RT,biochemical indicators and virological parameters of hepatitis B had been tested. The stages of fibro-sis and inflammation in these patients were determined by liver biopsy. The correlation between different indicators and stages of disease had been analyzed by univariate and multivariate analysis. Results Liver histopathological examination had been taken in all these 175 patients without se-rious adverse reactions. Among them,98 cases（56. 0% ）belonged to fibrosis stages of S0 ～ S2 and 77 cases at S3 ～ S4（44. 0% ）. Among In-flammatory grades,87 cases（49. 7% ）belonged to G0 ～ G2 and 88 cases（50. 3% ）belonged to G3 ～ G4. Age range,AST,albumin,total bili-rubin,platelet count,MPV and RDW of patients at S3 ～ S4 stages were higher than those of patients at S0 ～ S2 stages（ P ﹤ 0. 05）. ALT,AST, albumin,total bilirubin,platelet count,MPV and RDW of patients at G3 ～ G4 stages were higher than those of patients at G0 ～ G2 stages（ P ﹤0. 05）. Multivariate Logistic regression analysis showed that age,AST,albumin,total bilirubin,platelet count,MPV and RDW were correlated with fibrosis stages（ P ﹤ 0. 05）. ALT,AST,albumin,total bilirubin,platelet count,MCV,MPV and RDW were correlated with inflammation stages（ P ﹤ 0. 05）. RDW was the highest OR value. Conclusion RDW is a novel and efficient diagnostic marker for liver diseases,and it can provide diagnostic information for cirrhosis and inflammation,thus it can reduce the need of liver biopsy.