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本文对144例小儿乙型肝炎(乙肝)进行病理分型与临床关系的研究。结果表明,各型小儿乙肝临床与病理诊断总符合率为64.58%(93/144)。临床诊断为急性肝炎经病理证实为慢性肝炎者高达64.52%(20/31)。病理诊断为慢性活动型肝炎(CAH)者,临床误诊率为54.55%(30/55)。本文分析了与误诊有关的因素,又对经病理证实的各型乙肝临床特征进行了分析。着重提出,小儿慢性迁延型肝炎(CPH)与CAH 临床特征相似,不易鉴别,有几点可供参考:(1)CAH 多次高谷丙转氨酶(ALT)出现病例(41.82%)多于CPH(23.08%)(P<0.05)。(2)CAH 的血清胆红素(SB)均值(268.77μmol/L)明显高于CPH(63.75μmol/L)(P<0.01)。(3)在伴桥型坏死的CAH(17.86%)中凝血酶原活动度(PA)改变在40～60%,多于CPH(8.12%)。(4)γ.球蛋白升高的病例数,CAH(70.59%)显著多于CPH(35.21%)(P<0.05)。
In this paper, 144 cases of pediatric hepatitis B (hepatitis B) pathological classification and clinical research. The results showed that the total coincidence rate of clinical and pathological diagnosis of various types of children was 64.58% (93/144). Clinical diagnosis of acute hepatitis pathologically confirmed as chronic hepatitis were as high as 64.52% (20/31). Pathological diagnosis of chronic active hepatitis (CAH), clinical misdiagnosis rate was 54.55% (30/55). This article analyzes the factors associated with misdiagnosis, but also on the clinical features of various types of hepatitis B confirmed by pathology were analyzed. It is emphasized that the clinical features of chronic persistent hepatitis (CPH) in children and CAH are similar and difficult to identify. There are several points for reference: (1) There are more cases of CAH (41.82%) than CPH %) (P <0.05). (2) The mean serum SBB (268.77μmol / L) of CAH was significantly higher than that of CPH (63.75μmol / L) (P <0.01). (3) The change of prothrombin activity (PA) was 40-60% in CAH with bridge-type necrosis (17.86%), more than CPH (8.12%). (4) The number of cases with elevated γ globulin was significantly higher in CAH (70.59%) than that in CPH (35.21%) (P <0.05).