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目的:探讨如何对慢性乙型肝炎伴早期肝硬化者进行早期诊断。方法:选取经肝活组织病理检查确诊的80例慢性乙型肝炎伴早期肝硬化(早期LC)者作为研究对象,采集病史及体征,行肝功能和肝纤维化指标以及B超检查,并以同期随机抽取的80例单纯慢性乙型肝炎(CHB)患者作对照。结果:早期LC组患者的临床症状较重,某些体征(如蜘蛛痣、肝掌和肝病面容等)、血清总胆红素(TBil)、白/球蛋白比值(A/G)、凝血酶原活动度(PTA)和γ-球蛋白(γ-G)与CHB组比较均存在显著性差异(P<0.05),而血清丙氨酸转氨酶(ALT)与单纯慢乙肝组比较差异不显著(P>0.05);并且,早期LC组的血清透明质酸(HA)、C3氨基端肽(PⅢP)和板层素(LN)水平显著高于CHB组;此外,早期LC组的B超异常声像图(如肝内光点增粗、分布欠均匀、脾肿大和门静脉增宽等)明显高于CHB组。然而,两组之间HBsAg滴度高低和HBeAg阳性率却无明显差异(P>0.05)。结论:重视体格检查、肝功能化验和血清HA、PⅢP、LN以及B超产像图检查对慢性乙型肝炎合并早期LC的早期诊断具有较大的参考价值。
Objective: To explore how to make an early diagnosis of chronic hepatitis B with early cirrhosis. Methods: Eighty patients with chronic hepatitis B and early stage cirrhosis (early LC) diagnosed by liver biopsy were enrolled as subjects. Their medical history and signs were collected. Liver function, liver fibrosis indexes and B ultrasound examination were performed. In the same period, 80 patients with chronic hepatitis B (CHB) were randomly selected as control. Results: Early LC patients had severe clinical symptoms, some signs such as spider nevus, hepatomegaly and liver disease, TBil, A / G, thrombin PTA and γ-G were significantly different from those of CHB group (P <0.05), but there was no significant difference between serum ALT and chronic hepatitis B P> 0.05). Moreover, the levels of serum HA, PⅢP and LN in early LC group were significantly higher than those in CHB group. In addition, Image (such as intrahepatic spot thickening, uneven distribution, splenomegaly and portal vein widening, etc.) was significantly higher than the CHB group. However, there was no significant difference in HBsAg titers and HBeAg positive rates between the two groups (P> 0.05). Conclusion: Attention to physical examination, liver function tests and serum HA, P Ⅲ P, LN and B ultrasound imaging examination of early diagnosis of chronic hepatitis B with early LC has great reference value.