摘要
目的探讨肝活检组织学对丙氨酸转氨酶(ALT)在正常值上限2倍以内的慢性乙型肝炎(CHB)患者的临床意义。方法62例CHB患者接受彩色B超引导下快速经皮肝穿刺,全部病例血清HBsAg均为阳性,40U/L<ALT≤80U/L,病程超过6个月。肝组织切片由病理科医生盲法进行阅片。结果所有患者肝组织学显示肝内均有炎症、坏死及不同程度的纤维化存在。其中炎症活动度G2～G4为30例,占4838%;纤维化程度S2～S4为32例,占5161%。同时,肝脏的炎症活动度和纤维化程度与血清病毒复制的活跃程度不成正比。结论ALT轻度升高的CHB患者中仍有不少病例肝脏呈现明显组织学异常,不能只依靠血清ALT、病毒复制活跃程度来判断患者的肝损害程度,应重视肝组织病理学检查,将肝活检作为判断肝炎活动性和是否抗病毒治疗的主要依据。
Objective:To explore the histological features of chronic hepatitis B patients with ALT≤2×ULN and the clinical significance of liver biopsy for these patients.Methods:A total of 62 patients with HBV chronic infection undergone percutaneous liver biopsy by colour echo. All these patients were HBsAg positive and clinical course of more than six months. All liver biopsy specimens were assessed by experienced liver pathologists blinded to the liver biochemistry and scored according to standard criteria. Results: Hepatic histology of all these patients had showed inflammation and necrosis and different degree fibrosis.In the 62 patients,hepatic necrosis inflammation grade G2～G4 were 30 cases(48.38%) and hepatic fibrosis stage S2～S4 were 32 cases (51.61%). Hepatic necrosis inflammation grade and hepatic fibrosis stage increase out of proportion to the degree of HBV reproduction. Conclusion:Significant abnormal hepatic pathology was found still in these patients with chronic hepatitis B of lower degree ALT rise. Judgment of liver injure degree didnt only depend on the serum transaminases and the degree of HBV DNA replication. We should pay attention to checking of hepatic histology. Liver biopsy in chronic hepatitis B should be regarded as main basis of judgment the current activity of the disease, it also should be regarded as main basis if antiviral therapy should be conducted.
出处
《中西医结合肝病杂志》
CAS
2004年第6期337-338,共2页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
