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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 virological and pathological features of HBeAg-positive (e + CHB) and HBeAg-negative chronic hepatitis B (e-CHB) and the immunohistochemical characteristics of liver tissue and its internal rules. Methods According to inclusion criteria, 107 patients with e + CHB were selected; 102 patients with e-CHB were enrolled. Detection of biochemistry; Five hepatitis B; Quantitative HBV DNA; Liver tissue HE staining, MASSON staining and reticular fiber staining, pathological diagnosis; Knodell HAI score, fibrosis score; liver tissue immunohistochemistry semi-quantitative detection of HBsAg and HBcAg. Results The coincidence rate of clinical diagnosis and pathological diagnosis was 62.6% in e + CHB group and 72.5% in e-CHB group. The degree of fibrosis in e-CHB group was higher than e + CHB group, and the fibrosis score was higher (P <0.01). The HBV DNA load in e + CHB group was significantly higher than that in e-CHB group (t = 5.38, P = 0.000). There was a significant correlation between the scores of HBV DNA and G grade in e-CHB group (Pearson correlation coefficient: 0.24, P = 0.041). The positive expression of HBcAg in liver tissue was positively correlated with the serum HBV DNA level (P <0.01). Conclusion The pathological changes of liver tissue in patients with e-CHB are severe. Most of e + CHB and e-CHB patients have pathological damage. Promote timely liver biopsy, accurate diagnosis and timely anti-viral treatment.