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目的了解慢性乙型肝炎病毒(HBV)感染者肝脏病理特征,探讨其与血清学关系。方法采用回顾性分析方法,收集114例慢性HBV感染者,所有患者均行肝穿刺组织活检,同时检测肝功能、HBeAg和HBVDNA定量,分析肝组织炎症分级(G)和纤维化分期(S)与HBeAg状态、HBVDNA水平的关系。结果 114例患者中,113例(99.12%)患者肝组织发生病理改变,53例(46.49%)患者肝脏炎症分级和/或纤维化分期≥G2/S2。HBeAg阴性和HBeAg阳性患者年龄、血小板计数、HBVDNA水平差异有统计学意义,2组炎症分级差异无统计学意义(P>0.05),纤维化分期差异有统计学意义(P<0.05),Spearman相关性分析显示HBeAg与炎症分级和纤维化分期无关(r=-0.006,r=-0.147,P>0.05)。HBVDNA定量分层分析,≤5 lg拷贝/ml组、6~7 lg拷贝/ml组和≥8 lg拷贝/ml组HBeAg阴性患者分别为47例(83.93%)、8例(19.15%)和0例,≤5 lg拷贝/ml组和其余2组比较有统计学差异(P<0.05)。3组肝组织学≥G2/S2分别为33例(58.93%)、18例(42.86%)、2例(12.5%),≥8 lg拷贝/ml组和其余2组比较差异有统计学(P<0.05)。Spearman相关性分析显示HBVDNA水平与纤维化分期负相关(r=-0.279,P<0.05),与炎症分级无关(r=-0.091,P>0.05)。结论绝大部分慢性乙型肝炎病毒感染者有不同程度肝组织病理变化;HBeAg阴性患者较HBeAg阳性患者有更为严重肝脏病理变化,HBeAg状态与肝脏炎症和纤维化程度无关,HBVDNA水平和肝脏纤维化程度相关。
Objective To understand the pathological features of liver in patients with chronic hepatitis B virus (HBV) infection and to explore its relationship with serology. Methods Retrospective analysis was used to collect 114 patients with chronic HBV infection. All patients underwent biopsies of liver biopsies. The liver function, HBeAg and HBVDNA levels were also measured. Inflammatory grade (G) and fibrosis stage (S) HBeAg status, HBVDNA levels. Results Of the 114 patients, 113 (99.12%) patients had pathological changes in liver tissues, and 53 (46.49%) patients had liver inflammation grade and / or fibrosis stage ≥ G2 / S2. There were significant differences in age, platelet count and HBVDNA between HBeAg-negative and HBeAg-positive patients. There was no significant difference in the grade of inflammation between the two groups (P> 0.05), and the difference of fibrosis stage was statistically significant (P <0.05) Sex analysis showed that HBeAg was not associated with inflammation grade and fibrosis stage (r = -0.006, r = -0.147, P> 0.05). There were 47 cases (83.93%), 8 cases (19.15%) and 0 (0%) with HBeAg-negative HBVDNA in ≤5 lg copies / ml, 6-7 lg copies / ml and ≥8 lg copies / Cases, ≤ 5 lg copies / ml group and the other two groups were statistically significant (P <0.05). Three groups of liver histology≥G2 / S2 were 33 cases (58.93%), 18 cases (42.86%), 2 cases (12.5%) and 8lg copies / ml group and the other two groups, the difference was statistically significant <0.05). Spearman correlation analysis showed that the level of HBVDNA was negatively correlated with fibrosis stage (r = -0.279, P <0.05), but not with inflammation grade (r = -0.091, P> 0.05). Conclusions The majority of patients with chronic hepatitis B virus infection have different degrees of pathological changes of liver tissue. HBeAg-negative patients have more severe liver pathological changes than HBeAg-positive patients. HBeAg status has nothing to do with liver inflammation and fibrosis. HBVDNA level and liver fibrosis Degree related.