中国肝脏病杂志（电子版）
中國肝髒病雜誌（電子版）
중국간장병잡지（전자판）
CHINESE JOURNAL OF LIVER DISEASES(ELECTRONIC VERSION)
2013年
3期
12-17
,共6页
程佳%许诚%何清%艾书玲%唐奇远%乐晓华%周元平%苟继周
程佳%許誠%何清%艾書玲%唐奇遠%樂曉華%週元平%茍繼週
정가%허성%하청%애서령%당기원%악효화%주원평%구계주
肝炎,乙型,慢性%肝脏病理%主观差异
肝炎,乙型,慢性%肝髒病理%主觀差異
간염,을형,만성%간장병리%주관차이
Hepatitis B,chronic%Histopathology%Observer variation
目的通过分析不同阅片者对同一慢性乙型肝炎（CHB）患者肝组织病理切片结果诊断的主观性误差对比以了解肝组织病理这一金标准的可信程度。方法收集125例CHB患者肝组织活检术后病理切片（嗜银染色、HE染色、免疫组化）及病理学资料（炎症分级G、纤维化分期S、免疫组化HBcAg分布）。将病理切片交由另一位资深肝脏病理学家进行再次单盲阅片，统计阅片结果并与本院病理资料进行对比。结果收集两次阅片G分级123例，G0～4分级一致率分别为G016.67%、G125.8%、G221.05%、G353.85%、G425%，S分期125例，S0～4分期一致率分别为S072.7%、S117.4%、S265.5%、S354.84%、S445.16%，HBcAg不同分布117例，HBcAg分布呈阴性、浆型、核型、混合型的前后阅片一致率分别为77.42%、42.1%、75%、6.78%；对两次阅片G分期、S分期、HBcAg分布结果进行统计学分析，χ2=58.352、15.451、68.238；P=0.000、0.004、0.000。结论不同病理专家对相同的CHB患者肝组织病理切片的阅片结果存在较明显主观差异，尤其在判定G2/G3、S1/S2中。故临床应用肝脏病理结果这一“金标准”时仍需结合其他资料进行综合判断。
目的通過分析不同閱片者對同一慢性乙型肝炎（CHB）患者肝組織病理切片結果診斷的主觀性誤差對比以瞭解肝組織病理這一金標準的可信程度。方法收集125例CHB患者肝組織活檢術後病理切片（嗜銀染色、HE染色、免疫組化）及病理學資料（炎癥分級G、纖維化分期S、免疫組化HBcAg分佈）。將病理切片交由另一位資深肝髒病理學傢進行再次單盲閱片，統計閱片結果併與本院病理資料進行對比。結果收集兩次閱片G分級123例，G0～4分級一緻率分彆為G016.67%、G125.8%、G221.05%、G353.85%、G425%，S分期125例，S0～4分期一緻率分彆為S072.7%、S117.4%、S265.5%、S354.84%、S445.16%，HBcAg不同分佈117例，HBcAg分佈呈陰性、漿型、覈型、混閤型的前後閱片一緻率分彆為77.42%、42.1%、75%、6.78%；對兩次閱片G分期、S分期、HBcAg分佈結果進行統計學分析，χ2=58.352、15.451、68.238；P=0.000、0.004、0.000。結論不同病理專傢對相同的CHB患者肝組織病理切片的閱片結果存在較明顯主觀差異，尤其在判定G2/G3、S1/S2中。故臨床應用肝髒病理結果這一“金標準”時仍需結閤其他資料進行綜閤判斷。
목적통과분석불동열편자대동일만성을형간염（CHB）환자간조직병리절편결과진단적주관성오차대비이료해간조직병리저일금표준적가신정도。방법수집125례CHB환자간조직활검술후병리절편（기은염색、HE염색、면역조화）급병이학자료（염증분급G、섬유화분기S、면역조화HBcAg분포）。장병리절편교유령일위자심간장병이학가진행재차단맹열편，통계열편결과병여본원병리자료진행대비。결과수집량차열편G분급123례，G0～4분급일치솔분별위G016.67%、G125.8%、G221.05%、G353.85%、G425%，S분기125례，S0～4분기일치솔분별위S072.7%、S117.4%、S265.5%、S354.84%、S445.16%，HBcAg불동분포117례，HBcAg분포정음성、장형、핵형、혼합형적전후열편일치솔분별위77.42%、42.1%、75%、6.78%；대량차열편G분기、S분기、HBcAg분포결과진행통계학분석，χ2=58.352、15.451、68.238；P=0.000、0.004、0.000。결론불동병리전가대상동적CHB환자간조직병리절편적열편결과존재교명현주관차이，우기재판정G2/G3、S1/S2중。고림상응용간장병리결과저일“금표준”시잉수결합기타자료진행종합판단。
Objective To assess the credibility of liver biopsy which is considered to be a gold standard for ifbrosis evaluation. Methods The pathological sections (silver staining, HE staining, immunohistochemistry) of 125 patients with chronic hepatitis B were collected. These sections were single-blind read by the other pathologist. All results were compared and analyzed. Results Total of 123 pathological sections of different hepatic histological inlfammation (G) were collected, with coincidence rates of G0 to G4 are 16.67%, 25.80%, 21.05%, 53.85% and 25.00%, respectively, there’s significant difference (χ2= 58.352, P = 0.000); 125 pathological sections of different liver ifbrosis (S) stages were collected, and coincidence rates of S0 to S4 were 72.70%, 17.40%, 65.50%, 54.84%and 45.16%, respectively, with signiifcant difference (χ2=15.451, P=0.004);117 pathological sections of different distribution types of HBcAg were collected, coincidence rates of HBcAg negative, cytoplasm distribution, nuclei distribution and mixed type distribution were 77.42%, 42.10%, 75.00%and 6.78%, respectively, with signiifcant difference (χ2=68.238, P=0.000). Conclusions There’s signiifcant differences among the results given by different pathological professors viewing the same liver biopsy from patients with chronic hepatitis B, especially in assessing liver biopsy of G2 or G3 and S1 or S2. Thc assessment of liver biopsy should be made in combination with other clinical data.
