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目的了解血清学标志阴性的慢性肝炎患者病理与临床特征。方法对62例血清学标志阴性反复肝功能异常的肝炎患者进行血清肝炎病毒学检测、肝穿刺病理和免疫组化检查、肝功能和凝血功能检查,对其中乙肝患者采用荧光定量 PCR 方法检测血清乙肝病毒 DNA(HBV DNA)。结果 62例患者临床诊断与病理诊断的符合率为53.2%,慢性肝炎轻度的符合率较高为69.1%。62例患者肝组织免疫组化检查示28例(45.2%)HBsAg 和/或 HBcAg 阳性,可确诊为乙型肝炎。28例乙肝患者肝组织病理均有炎症病变,其中 G1最高占13例(46.4%),其次 G2占10例(35.7%),G4最少占2例(7.1%);肝纤维化分期 S0占12例(42.9%),S1占7例(25%),S4最少占1例(3.6%)。28例患者中10例(35.7%)检测血清 HBV DNA 阳性,平均(3.3±2.2)×10~3拷贝/ml,肝脏炎症分级及纤维化分期各组之间血清 HBV DNA 定量水平比较差异无统计学意义(P>0.05)。HBV DNA 阳性和阴性患者的各项指标比较差异无统计学意义(均 P>0.05)。乙肝患者和非乙肝患者各项指标比较差异无统计学意义(均 P>0.05)。结论血清学标志阴性 HBV 感染仍是我国原因不明肝病的主要病因之一,且多为慢性肝炎,HBV DNA 仍低水平复制,临床表现轻,炎症分级和纤维化程度较轻,但仍可发展为肝硬化。
Objective To understand the pathological and clinical features of patients with chronic hepatitis with negative serological markers. Methods Totally 62 cases of hepatitis patients with negative serological markers negative recurrent liver dysfunction were tested for serum hepatitis virulence, liver biopsy and immunohistochemistry, hepatic function and coagulation function. The hepatitis B patients were detected by real-time quantitative PCR Viral DNA (HBV DNA). Results The coincidence rate of clinical diagnosis and pathological diagnosis of 62 patients was 53.2%, and the mild coincidence rate of chronic hepatitis was 69.1%. 62 patients with immunohistochemical examination of liver tissue showed 28 cases (45.2%) of HBsAg and / or HBcAg positive, can be diagnosed as hepatitis B. The pathological changes of hepatic tissue in 28 patients with hepatitis B were all inflammatory lesions, of which G1 was the highest in 13 cases (46.4%), followed by G2 in 10 cases (35.7%), G4 was the least in 2 cases (7.1%), liver fibrosis staging S0 was 12 Cases (42.9%), S1 accounted for 7 cases (25%), S4 accounted for at least 1 case (3.6%). Serum HBV DNA was positive in 10 cases (35.7%) of 28 patients (mean 3.3 ± 2.2) × 10 ~ 3 copies / ml, no statistical difference was found in the quantitative levels of serum HBV DNA between the groups of inflammation grade and fibrosis stage Significance (P> 0.05). There was no significant difference in the indexes of HBV DNA positive and negative patients (all P> 0.05). The indexes of hepatitis B patients and non-hepatitis B patients had no significant difference (all P> 0.05). Conclusions Serological marker negative HBV infection is still one of the major causes of unknown liver disease in our country. Most of them are chronic hepatitis, HBV DNA is still low-level replication, clinical manifestations are light, inflammation grade and fibrosis degree is mild, but still can develop into Cirrhosis.