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目的研究慢性乙型肝炎病毒携带者肝活检组织病理改变,为临床治疗提供一定依据。方法选取慢性乙型肝炎病毒携带者73例,行肝穿刺病理检查,进行组织病理学炎症分级和纤维化分期,并检测血清HBVDNA定量。结果 73例慢性乙型肝炎病毒携带者中G0 3例(4.10%),G1 28例(38.36%),G2 35例(47.94%),G3 6例(8.22%),G4 1例(1.37%),S0 11例(15.07%),S1 30例(41.10%),S2 23例(31.51%),S3 8例(10.96%),S4 1例(1.37%)。按年龄分组,≥40岁年龄组肝脏炎症程度重于<40岁年龄组,差异有统计学意义(χ2=6.462,P=0.04)。两组间纤维化程度差异无统计学意义(P>0.05),但≥40岁年龄组S2~4占53.4%,<40岁年龄组以下年龄组S2~4仅占37.2%。血清HBV DNA定量水平与肝脏炎症分级及纤维化分期无明显相关性(r=0.012,P=0.918及r=-0.149,P=0.208)。结论绝大多数慢性HBV携带者的肝脏有一定程度的炎症改变,伴或不伴有肝脏纤维化。对慢性HBV携带者,尤其是年龄超过40岁者,建议行肝穿刺活检以指导临床诊断及治疗。
Objective To study the pathological changes of liver biopsy in patients with chronic hepatitis B virus infection and provide some evidences for clinical treatment. Methods 73 cases of chronic hepatitis B virus carriers were selected for pathological examination of liver biopsy, histopathological grade and fibrosis staging, and detection of serum HBVDNA quantitative. Results Among 73 cases of chronic hepatitis B virus carriers, G0 was found in 3 cases (4.10%), G1 in 28 cases (38.36%), G2 in 35 cases (47.94%), G3 in 6 cases (8.22% , S0 11 cases (15.07%), S1 30 cases (41.10%), S2 23 cases (31.51%), S3 8 cases (10.96%) and S4 one case (1.37%). According to age group, the degree of liver inflammation in the group of ≥40 years old was heavier than that in the group of <40 years old, the difference was statistically significant (χ2 = 6.462, P = 0.04). There was no significant difference in the degree of fibrosis between the two groups (P> 0.05). However, S2 ~ 4 accounted for 53.4% of the patients in the age group of 40 and only 37.2% of the patients in the age group of <40 years old. There was no significant correlation between serum HBV DNA level and liver inflammation grade and fibrosis stage (r = 0.012, P = 0.918 and r = -0.149, P = 0.208). Conclusions The liver of the vast majority of chronic HBV carriers has some degree of inflammatory changes with or without hepatic fibrosis. For chronic HBV carriers, especially those over the age of 40, liver biopsy is recommended to guide clinical diagnosis and treatment.