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目的探讨慢性乙型肝炎患者血清丙氨酸转氨酶(ALT)、总胆红素(TBiL)及凝血酶原活动度(PT%)与肝组织病理炎症分级和纤维化分期的关系。方法选择2007年1月～2009年2月住院治疗的89例慢性乙型肝炎患者作为研究对象,测定其血清ALT、TBiL、PT%水平,同时行肝活体组织检查,对肝脏进行炎症分级和纤维分期。分析ALT、TBiL及PT%与肝组织病理之间的关系。结果ALT随炎症程度和纤维化程度的上升而上升,不同的炎症分级和纤维化分期患者中,均以G4、S4组最高,G1、S1组最低。ALT在炎症分级各组间比较差异有统计学意义,在纤维化分期各组间比较差异无统计学意义。TBiL随炎症程度和纤维化程度的升高而上升,不同的炎症分级和纤维化分期患者中,以G4、S4组最高,G1、S1组最低。TBiL在炎症分级和纤维化分期各组间比较差异均有统计学意义。PT%随炎症程度和纤维化程度的上升而下降,不同的炎症分级和纤维化分期患者中,以G4、S4组最低,G1、S1组最高。PT%在炎症分级和纤维化分期各组间比较差异均有统计学意义。结论血清TBiL和PT%既能反映肝脏的炎症程度又能反映肝脏的纤维化程度,ALT仅能反映肝脏的炎症程度,不能反映肝脏的纤维化程度。因此,血清TBiL和PT%与肝组织病理有更好的相关性。
Objective To investigate the relationship between the serum levels of alanine aminotransferase (ALT), total bilirubin (TBiL) and prothrombin activity (PT%) in patients with chronic hepatitis B and histopathological grade and fibrosis stage. Methods Eighty-nine patients with chronic hepatitis B admitted to hospital from January 2007 to February 2009 were enrolled in this study. Serum levels of ALT, TBiL and PT% were measured. Liver biopsy was performed simultaneously to assess the grade of inflammation and fibrosis Staging. The relationship between ALT, TBiL and PT% and liver histopathology was analyzed. Results ALT increased with the degree of inflammation and the degree of fibrosis. Among the patients with different grades of inflammation and fibrosis, the highest was in groups G4 and S4, while the lowest in groups G1 and S1. ALT in the inflammation grading between the groups were statistically significant differences in the fibrosis staging between the groups was no significant difference. TBiL increased with the degree of inflammation and the degree of fibrosis, different inflammation grading and fibrosis staging patients, the highest in G4, S4 group, G1, S1 group the lowest. TBiL in inflammation grading and fibrosis staging differences between the groups were statistically significant. The percentage of PT decreased with the degree of inflammation and the degree of fibrosis. Among the patients with different grades of inflammation and fibrosis, the lowest in G4 and S4 group and the highest in G1 and S1 group. PT% in the inflammation grading and fibrosis staging differences between the groups were statistically significant. Conclusion Serum TBiL and PT% can reflect not only the degree of liver inflammation but also the degree of liver fibrosis. ALT can only reflect the degree of liver inflammation and can not reflect the degree of liver fibrosis. Therefore, serum TBiL and PT% have a better correlation with liver histopathology.