目的 探讨肝组织病理检查对隐匿性慢性乙型肝病的诊断价值.方法 对98例血清HBsAg阴性、肝功能不明原因反复异常患者采用免疫组化Envision法和肝组织HBV DNA的原位杂交法检测肝组织中HBsAg、HBcAg水平,采用实时荧光定量聚合酶链反应(FQPCR)检测血清HBV DNA水平,并在光学显微镜下观察肝组织病理改变的情况.结果 肝组织病理检查示:98例患者中,隐匿性慢性乙型肝炎73例,隐匿性乙型肝炎后肝硬化20例,早期肝细胞癌5例;98例患者肝组织HBV DNA原位杂交法检测阳性率为74.49%(73/98),明显高于血清HBV DNA检测的阳性率7.14%(7/98)(P＜0.01)和免疫组化Envision法检测HBsAg、HBcAg的阳性率50.02%(50/98)、30.73%(36/98)(P＜0.05).结论 肝组织病理检查对隐匿性慢性乙型肝病有重要的诊断价值.%Objective To explore the value of liver histopathological examination in diagnosis of occult chronic hepatitis B hepatic disease.Methods Ninety-eight cases patients with serum HBsAg negative and unexplained recurrent abnormal liver function cases were detected the level of HBsAg,HbcAg in liver tissue by Envision immunohistochemistry method, detected the HBV DNA in liver tissue by in situ hybridization,detected the level of HBV DNA in serum by real-time fluorescence quantitative polymerase chain reaction (FQ-PCR) and observed pathological changes of liver under light microscope in liver tissue.Results the liver tissue histopathological examination revealed:98 patients indicated that 73 cases are occult chronic hepatitis B hepatitis,20 cases are occult hepatitis B hepatitis cirrhosis,5 cases are early hepatocellular carcinoma.In 98 patients,the positive rate of HBV DNA in liver tissue detected by in situ hybridization was 74.49％ (73/98),higher than the positive rate of serum HBV DNA (7.14％,7/98) (P＜0.01) and the positive rate of HBsAg, HBcAg detected by Envision immunohistochemistry method 50.02％ (50/98) ,30.73％(36/98) (P＜0.05).Conclusion The value of the liver histopathological examination in diagnosis of occult chronic hepatitis B hepatic disease are important.
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