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为探讨晚期血吸虫病(晚血)临床资料和组织学检查之间的关系,本文分析46例来自疫区的经临床诊断为晚血患者的临床和组织学资料。组织学资料显示,22例患者(47.8%)为血吸虫性肝纤维化,合并慢活肝者达16例(34.8%),8例(17.4%)为结节性肝硬变。后二者患者中,肝内HBsAg阳性率(分别为62.5%和87.5%)和谷丙转氨酶(GPT)反复异常率(68.8%和100%)均高于前者的18.2%和18.2%(P<0.05),且病理变化多见碎片状坏死和桥状坏死(可能主要由HBV感染所致)。提示目前在疫区临床诊断的晚血患者中,某些患者合并有慢活肝,某些患者本身患的即是结节性肝硬化而被误诊为晚血。因此,对临床诊断为晚血,但具有HBV感染标志和谷丙转氨酶反复异常者,应警惕合并慢活肝或结节性肝硬变的可能。重视其鉴别诊断,对于改善晚血的预后具有重要意义。
In order to explore the relationship between clinical data and histological examination of advanced schistosomiasis (late blood), 46 clinical and histological data of clinically diagnosed late blood from infected areas were analyzed. Histological data showed that 22 patients (47.8%) were schistosomiasis hepatic fibrosis with 16 (34.8%) patients with slow-acting liver and 8 (17.4%) with nodular cirrhosis change. Among the latter two patients, the positive rate of HBsAg in the liver (62.5% and 87.5%, respectively) and the recurrence rate of alanine aminotransferase (GPT) were higher than those in the former 18 (68.8% and 100%). 2% and 18.2%, respectively (P <0.05), and the pathological changes were more fragmented and bridge necrosis (probably caused by HBV infection). It is suggested that some of the patients with late-onset blood in the clinical diagnosis of epidemic-affected areas are complicated with slow-lived liver. Some patients are themselves suffering from nodular cirrhosis and are misdiagnosed as late blood. Therefore, clinical diagnosis of late blood, but with signs of HBV infection and alanine aminotransferase abnormalities repeatedly, should be alert to the possibility of combining slow-living or nodular cirrhosis. Pay attention to its differential diagnosis, to improve the prognosis of late blood is of great significance.