摘要
目的探讨HBeAg阳性(e+CHB)与HBeAg阴性慢性乙型肝炎(e-CHB)病毒学、病理学及肝组织免疫组化的特征、差异及其内在规律。方法按照纳入标准选择e+CHB患者107例;e-CHB患者102例。检测生化学;乙肝五项;HBV DNA定量;肝组织HE染色,MASSON染色及网状纤维染色,进行病理诊断;Knodell HAI评分,纤维化评分;肝组织免疫组化半定量法检测HBsAg、HBcAg。结果临床诊断与病理诊断符合率e+CHB组62.6%,e-CHB组72.5%;e-CHB组纤维化程度较e+CHB组重,纤维化评分较高(P<0.01)。e+CHB组HBV DNA载量明显高于e-CHB组,有统计学差异(t=5.38,P=0.000)。e-CHB组HBV DNA载量和G分级、评分间有相关性(Pearson相关系数:0.24,P=0.041);肝组织HBcAg表达强度与血清HBV DNA定量间正相关(P<0.01)。结论 e-CHB患者肝组织病理损害较重;e+CHB和e-CHB患者绝大部分存在病理损害。提倡适时进行肝穿刺活检,准确诊断和及时抗病毒治疗。
Objective To investigate the relationship between HBeAg and liver function,HBV virology,liver/immunohistochemistry and histopathology.Methods 107 patients with HBeAg positive chronic hepatitis（e＋CHB）B and 102 patients with HBeAg negative chronic hepatitis B（e-CHB）were observed and compared,and HBV-DNA,serum ALT,AST,total biliary,HbsAg,HbeAg were detected in the patients of both groups.All the patients received liver biopsy,and the patients＇ histological inflammation grade （G）,fibrosis stage （S） were detected by immunohistochemistry.Results The clinical diagnosis of 62.6% e＋CHB patients and 72.5% e-CHB patients were confirmed by liver histopathology.The liver fibrosis of e-CHB patients was more severe than that of patients with e＋CHB.The HBV-DNA levels of e＋ CHB patients were significantly higher than those of e-CHB patients （P0.01）.There was no significant difference in liver histopathological changes between e-CHB patients and e＋ CHB patients.There was a correlation between histological inflammation grade and HBV DNA in e-CHB patients （P0.05）.There was a positive correlation between HBcAg in liver tissues and the serum levels of HBV DNA（P0.01）.Conclusion There exists pathological injury in most e＋CHB patients and e-CHB patients.So,liver biopsy is recommended and necessary in CHB patients for accurate diagnosis and anti-HBV therapy.
出处
《河北医药》
CAS
2010年第21期2962-2964,共3页
Hebei Medical Journal
