Clinical Analysis Of Liver Histopathology In 104 Patients With Acute And Chronic Liver Disease

[Objective]:To summarize the role of liver histopathological examination in the diagnosis,and treatment of non-viral liver injury with unknown cause and the timing of antiviral therapy in chronic HBV carrying state through clinical retrospective analysis APRI?FIB-4 104 cases of acute and chronic liver disease.[Methods]According to the inclusion and exclusion criteria,104 inpatients were collected from September 2015 to December 2019 in geriatrics/general medicine department,hepatobiliary and pancreatic vascular surgery,Calmette Hospital affiliated to Kunming Medical University.(1)52 cases of ultrasound-guided liver puncture biopsy:?38 cases of non-viral liver injury with unknown cause of liver injury,21 cases of male and 17 cases of female,age range 14-72 years old;?cases of chronic HBV infection 14 cases,10 cases of male and 4 cases of female,age range 37-62 years old.(2)Patients with hepatitis B cirrhosis liver transplantation,52 cases of recipient liver pathological results,44 cases of men and 8 cases of women,the age range is 29-68 years old.The biopsy of liver puncture was performed by the same physician in ultrasonic medicine department under the guidance of B super-guided Automatic ejection biopsy gun and 18 G biopsy needle produced by Bud Company of the United States.The pathological results of liver puncture were recorded in detail,and the etiology composition of non-viral liver injury was analyzed in combination with pathological diagnosis.To analyze whether serum ALT levels of chronic HBV infected patients with 14 cases of liver biopsy have some correlation with liver pathology.the patients with all chronic HBV were divided into two groups according to pathological results,no cirrhosis group(S1-S3)and liver cirrhosis group(S4).the APRI?FIB-4 values were calculated,the correlation with hepatitis b liver fibrosis was analyzed,and the accuracy,sensitivity,specificity,negative predictive value and positive predictive value of non-invasive diagnostic model were evaluated APRI?FIB-4 and the ROC curves were plotted.Application of SPSS 22.0 software for statistical analysis of the data.[Results]1.Thirty-six patients(94.7%)were diagnosed with non-viral liver injury and unexplained liver injury.There were 17 cases(44.7%)of autoimmune liver diseases,including 11 cases of primary biliary cholangitis(28.8%),4 cases of AIH-PBC overlap syndrome(10.6%),2 cases of autoimmune hepatitis(5.3%),7 cases of drug-induced li ver injury(18.4%),5cases of alcoholic liver disease(13.1%),4 cases of non-alcoholic fatty liver disease(10.6%),2 cases of hepatic sinus obstruction syndrome(10.6%),1 ca se of Dubin-Johnson syndrome(2.6%)and 2 cases(5.3%)of unclear etiology.2.Patients with chronic HBV from liver biopsy were divided into normal group 10 cases and abnormal group 4 cases according to ALT level.Liver pathological result-s showed that all patients had varying degrees of inflammation and fibrosis.These included 4 G1S3;4 G2S1;4 G2S2;2 G2S3.3.66 patients with chronic HBV were divided into liver cirrhosis group(S1-S3)and liver cirrhosis group(S4).(1)AST?PLT?albumin,APRI,and FIB-4 levels in patients with different degrees of fibrosis were statistically significant(P<0.05).(2)There was significant positive correlation between the degree of fibrosis and the le vel of AST?APRI?FIB-4(P<0.05),and the correlation coefficients were 0.359,0.651,0.679,respectively.There was significant negative correlation between the degree of fibrosis and the level of ALT?PLT?albumin(P<0.05).The correlation coefficients were-0.328 and-0.646,-0.548.There was no significant correlation between the degr ee of fibrosis and age(P>0.05),and the correlation coefficient was-0.101.(3)The AST?APRI?FIB-4 level of patients in hepatitis B cirrhosis group(S4)was hi gher than that in patients without cirrhosis group(S1-S3),and ALT?PLT?albumin le vel was lower than that in patients without cirrhosis group(S1-S3),the difference was statistically significant(P<0.05).Gender and age comparison between the two groups,the difference was not statistically significant(P>0.05).APRI?FIB-4 had significant diagnostic value(P<0.05)in the hepatitis b cirrhosis group(CI,0.888-0.995),with AU C of 0.966(95%)and 0.981(95%(CI,0.913-0.999).There was no significant differenc e between the diagnostic value of APRI and FIB-4(P>0.05).When the APRI threshol d is 0.82,the sensitivity,specificity and PPV?NPV?accuracy of diagnosis of hepatitis B cirrhosis are 90.38,92.31,97.93,70.62,90.91%,and when the FIB-4threshold is 0.98,the sensitivity,specificity and PPV?NPV?accuracy of diagnosis of hepatitis B cirrho sis are 96.15,100.00,100.00,87.56 and 96.97%,respectively.[Conclusion]1.Histopathological examination of liver puncture has high diagnostic value for non-viral liver injury and unexplained liver injury(94.7%).2.Autoimmune liver disease,drug-induced liver injury in non-viral liver injury unkn own cause of liver injury accounted for a high proportion.3.ALT levels do not fully reflect liver histological changes.4.Liver biopsy can make up for the choice of antiviral therapy timing for ALT persist ently normal HBV-DNA positive patients.5.APRI?FIB-4 the accuracy,specificity,sensitivity and positive predictive value of the non-invasive diagnostic model of serology in the diagnosis of chronic hepatitis B cirrhosis,it has certain diagnostic significance.