中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2011年
1期
29-32
,共4页
林巍%潘陈为%诸葛璐%郑毅%周光耀%方周溪%吕夕明%金玲湘
林巍%潘陳為%諸葛璐%鄭毅%週光耀%方週溪%呂夕明%金玲湘
림외%반진위%제갈로%정의%주광요%방주계%려석명%금령상
肝炎,乙型,慢性%细胞外基质%超微结构%肝细胞
肝炎,乙型,慢性%細胞外基質%超微結構%肝細胞
간염,을형,만성%세포외기질%초미결구%간세포
Chronic hepatitis B%Extracellular matrix%Ultramicrostructure%Hepatocytes
目的 探讨轻度慢性乙型肝炎(CHB)患者细胞外基质和肝脏超微结构改变与临床的相关性.方法 选择慢性HBV感染者为研究对象,将其分为轻度CHB组(66例)和慢性HBV携带组(10例).对所有患者采集血清,并行肝穿刺活检,光镜和电镜下观察样本,将结果与血清生化学等指标进行对比分析.计量资料比较采用t检验,计数资料比较采用χ2检验,等级资料相关性使用非参数Spearman 分析.结果 轻度CHB组和慢性HBV携带组在ALT和AST两项指标上比较差异有统计学意义(t=12.42和7.06,P<0.05),但HBV DNA水平差异无统计学意义(t=0.24,P>0.05).两组患者血清肝纤维化指标(透明质酸、Ⅲ型胶原、Ⅳ型胶原和层黏连蛋白)差异均无统计学意义(t=0.45、0.95、0.76和1.21,P值均>0.05).光镜组织学结果显示,轻度CHB组中,G2、S2以上的患者为33例,慢性HBV携带组为2例,两组差异有统计学意义(χ2=4.17,P<0.05).轻度CHB组S3~4的患者(17例)明显多于慢性HBV携带组(0例,χ2=4.75,P<0.05).电镜超微结构表现,狄氏间隙胶原纤维增生、汇管区扩大、贮脂细胞增生等反映肝脏纤维化相关的指标与光镜下纤维化分级相关系数分别为0.351、0.675和0.301(P值分别为0.004、0.000和0.014).结论 电镜下肝脏超微结构改变敏感性较光镜高,对轻度CHB患者的病情评估具有重要价值.
目的 探討輕度慢性乙型肝炎(CHB)患者細胞外基質和肝髒超微結構改變與臨床的相關性.方法 選擇慢性HBV感染者為研究對象,將其分為輕度CHB組(66例)和慢性HBV攜帶組(10例).對所有患者採集血清,併行肝穿刺活檢,光鏡和電鏡下觀察樣本,將結果與血清生化學等指標進行對比分析.計量資料比較採用t檢驗,計數資料比較採用χ2檢驗,等級資料相關性使用非參數Spearman 分析.結果 輕度CHB組和慢性HBV攜帶組在ALT和AST兩項指標上比較差異有統計學意義(t=12.42和7.06,P<0.05),但HBV DNA水平差異無統計學意義(t=0.24,P>0.05).兩組患者血清肝纖維化指標(透明質痠、Ⅲ型膠原、Ⅳ型膠原和層黏連蛋白)差異均無統計學意義(t=0.45、0.95、0.76和1.21,P值均>0.05).光鏡組織學結果顯示,輕度CHB組中,G2、S2以上的患者為33例,慢性HBV攜帶組為2例,兩組差異有統計學意義(χ2=4.17,P<0.05).輕度CHB組S3~4的患者(17例)明顯多于慢性HBV攜帶組(0例,χ2=4.75,P<0.05).電鏡超微結構錶現,狄氏間隙膠原纖維增生、彙管區擴大、貯脂細胞增生等反映肝髒纖維化相關的指標與光鏡下纖維化分級相關繫數分彆為0.351、0.675和0.301(P值分彆為0.004、0.000和0.014).結論 電鏡下肝髒超微結構改變敏感性較光鏡高,對輕度CHB患者的病情評估具有重要價值.
목적 탐토경도만성을형간염(CHB)환자세포외기질화간장초미결구개변여림상적상관성.방법 선택만성HBV감염자위연구대상,장기분위경도CHB조(66례)화만성HBV휴대조(10례).대소유환자채집혈청,병행간천자활검,광경화전경하관찰양본,장결과여혈청생화학등지표진행대비분석.계량자료비교채용t검험,계수자료비교채용χ2검험,등급자료상관성사용비삼수Spearman 분석.결과 경도CHB조화만성HBV휴대조재ALT화AST량항지표상비교차이유통계학의의(t=12.42화7.06,P<0.05),단HBV DNA수평차이무통계학의의(t=0.24,P>0.05).량조환자혈청간섬유화지표(투명질산、Ⅲ형효원、Ⅳ형효원화층점련단백)차이균무통계학의의(t=0.45、0.95、0.76화1.21,P치균>0.05).광경조직학결과현시,경도CHB조중,G2、S2이상적환자위33례,만성HBV휴대조위2례,량조차이유통계학의의(χ2=4.17,P<0.05).경도CHB조S3~4적환자(17례)명현다우만성HBV휴대조(0례,χ2=4.75,P<0.05).전경초미결구표현,적씨간극효원섬유증생、회관구확대、저지세포증생등반영간장섬유화상관적지표여광경하섬유화분급상관계수분별위0.351、0.675화0.301(P치분별위0.004、0.000화0.014).결론 전경하간장초미결구개변민감성교광경고,대경도CHB환자적병정평고구유중요개치.
Objective To investigate the correlations of extracellular matrix and hepatic ultramicrostructural changes with clinical manifestations in patients with mild chronic hepatitis B (CHB).Methods Patients with chronic HBV infections were enrolled and were divided into mild CHB group (n=66) and HBV carrier group (n=10).Serum samples were collected from patients, and serum HBV markers, HBV DNA load and liver fibrosis indexes were measured.All subjects received liver biopsy, and the tissue samples were observed by light microscope and electron microscope.T test and χ2 test were performed for measurement data and enumeration data, respectively.Spearman test was used for ranked data.Results The differences on ALT and AST levels between mild CHB group and HBV carrier group were significant (t=12.42, 7.06, P<0.05), but there was no significant difference on HBV DNA load between two groups (t=0.24, P > 0.05).Serum liver fibrosis indexes (hyaluronic acid, type Ⅲ collagen,type Ⅳ collagen and laminin protein) in mild CHB group were not significantly higher than those in HBV carrier group (t=0.45, 0.95, 0.76 and 1.21, P >0.05).In mild CHB group, there were 33 patients with ≥G2 and ≥S2, but in HBV carrier group were only 2 patients (χ2=4.17, P < 0.05).Seventeen patients in mild CHB group were with S3-4, while that was not observed in HBV carrier group (χ2=4.75, P <0.05).In mild CHB group, hepatic ultramicrostrutural changes on fat storing cell, collagen protein and portal area were correlated with fibrosis grades, and the correlation coefficients were 0.351, 0.675 and 0.301, respectively (P=0.004, 0.000 and 0.014).Conclusion Electron microscope is of higher sensitivity than light microscope in observing hepatic ultramicrostructural changes, which is effective in evaluating the severity of mild CHB.