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目的探讨慢性乙型肝炎(CHB)患者血清病毒标志与ALT及肝脏病理的关系。方法检测133例CHB患者血清病毒标记物和肝功能,同时全部患者接受彩色B超引导下快速经皮肝穿刺,将患者按HBeAg、HBV-DNA阳性与否及ALT正常与否分为8个组,对各组肝组织炎症和纤维化程度进行比较。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,血清转氨酶正常的患者仍有一部分肝内有不同程度的炎症及纤维化改变,有的甚至存在肝硬化;ALT异常、HBeAg阴性的慢性乙型肝炎患者肝脏炎症和纤维化程度更严重。血清病毒复制的活跃程度与肝组织病理损害程度不成正比。结论单凭血清转氨酶的升高、血清病毒复制活跃与否判断疾病活动性是不够的,在临床选择抗病毒治疗的适应证时,肝活检对此有不可取代的价值,应将肝活检作为判断肝炎活动性和是否需要抗病毒治疗的主要依据。
Objective To investigate the relationship between serum viral markers and ALT and liver pathology in patients with chronic hepatitis B (CHB). Methods Serum viral markers and liver function were measured in 133 patients with CHB. All the patients underwent rapid percutaneous transhepatic puncture under the guidance of color B ultrasound. The patients were divided into 8 groups according to HBeAg, HBV-DNA positive or not and ALT normal or not , The liver inflammation and fibrosis in each group were compared. Results All patients had histological liver inflammation, necrosis and varying degrees of fibrosis. Some patients with normal serum aminotransferase still had varying degrees of inflammation and fibrosis in the liver, and some even had cirrhosis. ALT Abnormal, HBeAg-negative chronic hepatitis B patients with liver inflammation and fibrosis more serious. Serum viral replication activity is not proportional to the degree of liver damage and pathological lesions. Conclusions It is not enough to determine the activity of the disease simply by the rise of serum aminotransferase and activity of serum viral replication. Liver biopsy has an irreplaceable value in the clinical selection of indications for antiviral therapy. Liver biopsy should be taken as a judgment Hepatitis activity and whether the need for antiviral therapy is the main basis.