| Objective:To investigate the value of liver histopathology in the diagnosis and treatment of chronic liver disease.Methods:To the First Affiliated Hospital of Kunming Medical University from January 2014 to December 2015 underwent ultrasound guided liver biopsy in 230 cases of chronic liver disease patients with clinical manifestations, laboratory examination and pathological features were analyzed retrospectively.Results:1. 230 cases of liver biopsy under ultrasound guidance were successful, the success rate was 100%.2. 230 patients with chronic liver disease were enrolled in the study, including 172 patients with chronic viral hepatitis. 170 cases of hepatitis B, 1 cases of chronic hepatitis C, 1 cases of hepatitis E; 58 cases of unexplained liver injury: 1 cases of patients with drug-induced liver injury; 13 cases of autoimmune hepatopathy;patients with nonalcoholic fatty liver disease in 2 cases; 1 cases of patients with coholic fatty liver disease, cholestasis in 1 cases of liver disease; 2 cases of liver hemochromatosis,1 cases of hepatic schistosomiasis; 1 cases of Dubin-Johnson syndrome,Gilbert syndrome in 2 cases,18 cases of unexplained chronic hepatitis,cirrhosis of unknown cause in 5 cases; 1 cases of liver abscess; 3 cases of hepatocellular carcinoma.3.230 cases of liver puncture biopsy patients, graded according to the degree of lesion,162 cases were mild, 47 moderate and 48 severe cases, another 3 cases of hepatocellular carcinoma, without pathological grading and staging, analysis of clinical manifestations between the three groups by the X2 test showed that there were significant differences between the three groups of clinical symptoms of nausea, vomiting, weight loss (P<0.05), liver pain, bloating, anorexia, fatigue,jaundice, anemia, gastrointestinal bleeding, ascites index between the three groups were no difference (P>0.05).4. There were 170 cases of chronic hepatitis B, mild in 133 cases, moderate in 28 cases, severe in 9 cases, G1 in 15 cases, G2 in 120 cases, G3 in 33 cases, G4 in 2 cases, SO in 67 cases, S1 in 61 cases, S2 in 23 cases, S3 in 11 cases, and S4 in all cases.5.In 170 chronic hepatitis B patients were grouped according to pathological examination results, analysis of 3 groups of laboratory indicators, by variance analysis, three groups of albumin, activated partial thromboplastin time (P<0.05),there was significant difference, after LSD-t test comparison showed that there was a statistically significant difference between mild group and moderate group and mild group and heavy groups of albumin (P<0.05); there was significant difference between mild group and severe group,moderate group and severe group of activated partial thromboplastin time (P<0.05) through multiple independent samples rank sum test showed that there were significant differences between the three groups of ALT, AST, TBIL, DBIL, globulin, total bile acid, r-glutamyl peptide,serumal kaline phosphatase, cholinesterase, alpha fetoprotein,carcinoembryonic antigen (P<0.05), there were no differences between the rest three groups index (P>0.05).6. Analysis of 170 cases of chronic hepatitis B patients age and severity and correlation, moderate negative correlations between inflammation grade and duration (r=-0.152, P=0.029), a low positive correlation between inflammatory grade and age (r=0.267, P<0.001); a low positive correlation between fibrosis and age (r=0.175, P=0.009). Chronic hepatitis B patients aged <40 years and above 40 years into 2 groups, the Spearman correlation analysis showed that there was low positive correlation between inflammatory grade and age (r=0.278, P=0.001); a low positive correlation between fibrosis and age (r=0.190, P=0.005). The X2 test showed that different age grades of inflammation (P>0.05); no significant difference among different ages and fibrosis had no statistical difference (P>0.05).7.170 patients with chronic hepatitis B were divided into positive group and negative group according to HBeAg,including HBeAg positive of 125 and negative in 55 cases. The two independent samples t test showed that there was a significant difference between the two groups in HBeAg (P<0.05). The X2 test showed that two groups of HBeAg between gender,grade,degree of inflammation and fibrosis were not statistically significant (P>0.05).8. The patients with HBV-BDA were divided into 1.0x103 group and above 1.0x105 group, 1.0x103-1.0x105 group and above 1.0x105 group, and the variance analysis showed that there was statistical difference between the age of the three groups(P<0.05). And then the comparison of the LSD-t test, 1.0x103 group and above 1.0x105 group, 1.0x103-1.0x105 group and the 1.0x105 group between the age of the statistical difference (P<0.05). The X2 test showed that three groups of inflammatory grade and fibrosis grading showed no difference (P>0.05).9. According to the analysis of the relationship between patients with transaminase level changes of hepatic tissue pathological features and ALT,the results showed that 170 cases of patients with chronic liver disease ALT < 80 patients in 146 cases,of which, G2 or S2, there were 120 cases (82.19%), ALT > 80 patients, 24 cases,the X2 test. Two groups of patients with inflammatory grade and fibrosis degree differences were statistically significant (P<0.001).10.170 cases of chronic HBV infection in 58 cases of liver Fibroscan liver instantaneous elasticity, the hardness of scanning structure and the severity of liver injury showed moderate positive correlation (r=0.552, P<0.001); liver hardness Kpa value is positively correlated with the degree of liver lesions (r=0.555,P<0.001).11. 58 cases of liver injury patients were analyzed, 20 cases of autoimmune liver disease, 13 cases of AIH patients (6 cases with positive serum ANA antibody, 3 cases of AMA-M2 antibody positive serum,1 cases of serum IgA and IgG increased), 5 cases of PBC patients (4 cases of serum ANA antibody positive, 2 cases with positive serum AMA-M2 antibody). 2 cases of AIH / PBC overlap syndrome (1 cases, ANA positive), 1 cases of nonalcoholic fatty liver disease, 2 cases of nonalcoholic fatty liver disease, 18 cases of liver injury etiology is not clear, analysis of 5 cases of liver cirrhosis patients with unexplained etiology,including 1 cases of considering nodular hyperplasia of liver cirrhosis, 1 cases considering the idiopathic portal hypertension. Other rare cases were drug-induced liver injury, cholestatic liver disease, liver schistosomiasis, liver hemochromatosis,Dubin-Johnson syndrome,Gilbert syndrome,Conclusion:1. Liver biopsy has the advantages of accurate positioning, high success rate, fewer complications, less injury, simple operation and reliable inspection results quickly,not only contributes to diagnosis and differential diagnosis of the disease, but also can be used for the staging of the disease and guide the treatment and therapeutic efficacy, and can be recommended as a routine method for chronic liver disease2. Analyze the main clinical manifestations of patients with chronic liver disease,found nausea,vomiting and weight loss have the reference value to assess the degree of liver lesion.3. The level of HBV-DNA, the course of chronic hepatitis B patients without reference to estimate the severity of the disease, and serum albumin, prothrombin time activated partial reference value, age and ALT evaluation of hepatic lesions, in clinic,4. The results showed that Fibroscan had a positive correlation with the severity of liver lesions, It was a reliable index to reflect the degree of liver fibrosis. and has the advantages of non-invasive, rapid and so on. It can be widely used in clinical5. In the case of unexplained liver injury, our study shows a clear diagnostic rate of 63.79%, which is a valuable diagnostic tool for liver biopsy of unknown causes. |
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