目的 探讨临床诊断为轻度慢性乙型肝炎患者的肝组织病理学特点及其肝穿刺活检的重要意义.方法 选择156例轻度慢性乙型肝炎患者进行肝穿刺活检及肝组织病理学检查,对临床诊断与病理诊断的结果进行对比分析.结果 经病理诊断为轻度慢性乙型肝炎者为105例,临床诊断与之的符合率为67.3%(105/156),中度28例(18.0%)、重度3例(1.9%)、肝硬化20例(12.8%);另外,肝组织炎症分级为G3～4者共48例(30.8%),纤维化分期为S3～4者共39例(25.0%);病理诊断为轻度慢性乙型肝炎与非轻度者之间的ALT、AST、Tbil和ALB水平差异无统计学意义.结论 对于临床诊断轻度慢性乙型肝炎患者最好行肝脏穿刺活检,以便更好指导诊断和抗病毒治疗.%Objective To study the pathological features of liver tissues from patients clinically diagnosed with mild chronic hepatitis B based on current guideline and emphasize the important significance of liver puncture and biopsy for these patients. Methods Totally 156 patients clinically diagnosed with mild chronic hepatitis B based on current guideline received liver puncture under the real-time Doppler ultrasonographic guiding. Pathological diagnosis was made after microscopic examinations of the liver tissue specimens stained with hematoxylin-eosin (HE) and reticular fiber staining. The differences between clinical and pathological diagnosis for these patients were analyzed. Results Finally, 105 (67.3%) patients were pathologically diagnosed with mild chroniehepatitis B; 28 (18.0%), 3 (1.9%) and 20 (12.8%) patients were pathologically diagnosed as moderate, severe chronic hepatitis B and cirrhosis, respectively. Forty-eight (30.8%) and 39 (25.0%) patients of non-mild chronic hepatitis B were found to have G3-4 inflammation and S3-4 fibrosis, respectively. Differences in serum alanine aminotransferase, aspartate aminotransferase, total bilirubin or albumin between mild and non-mild chronic hepatitis B based on pathological diagnosis were not statistically significant (t-test, P > 0.05 ). Comclusions Accurate pathological diagnosis is helpful to guiding an antiviral therapy.
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