Guiding Effect Of Hepatic Ultrastructure On The Antiviral Therapy Of CHB By Ultrasound-guided Puncture

HBV infection is epidemical worldwide and China is a high-incidence area. With the continuous research and clinical observation on HBV, the diagnosis of CHB also changed. After the setting-up of the Introduction and Guidance Program of China's Hepatitis B Prevention and Control in 2005, clinical diagnosis of chronic hepatitis B has been divided into two types: HBeAg(+)CHB and HBeAg (-)CHB. Also a kind of Occult CHB exist in HBeAg (-) CHB, which is easy to be missed during clinical diagnosis. How to control the level replication and measure virus detection of HBeAg virus become the key to the treatment of CHB. Since there are no clear diagnostic criteria on the majority of molecular biology research, the author studies the serum and liver tissue of ultrastructure, as well as their respective diagnostic values on the research of different types of CHB.Experiment 1Be objective to observe the relativity between serum index and inflammatory grading by comparing the pathological results and serum index. The comparison between G1 and G2 is the focus of this study. Methods: According to the integrated clinical data choosing from 187 cases of new patients admitted to Medicine Digest Section, China-Japan Friendship Hospital, Jilin University, the author made the serological test for liver function, the clotting time and ultrasound, and liver biopsy diagnosis. At the same time, the author analyzed the statistics by using the SPSS11.0 statistical software. The comparative result is as follows: 1) Serum AST, Alb, TBil, PT has the statistical values in the different pathological grades of HBsAg (+) CHB. The distinction between ALT and AST has the statistical values between G1 and G2,G1-G2 and G4, G3 and G4 (p<0.05); the distinction between Alb has the statistical values between G1 and G3,G1-2 and G4 (p<0.05); the distinction between TBil has the statistical values between G1-2 and G4 (p<0.05); the PT distinction has the statistical values between G1 and G3, G4 (p<0.05). The other groups had no difference between the each other; ALP and GGT have no statistical values among different pathological grades of G1,G2,G3,G4. 2) Serum AST, Alb, TBil, PT has the statistical values in the different pathological grades of HBsAg(-)CHB. The distinction between ALT and AST has the statistical values between G1 and G2-G4 (p<0.05); the distinction between Alb and TBil has the statistical values between G1 and G1-2 and G4 (p<0.05); the PT distinction has the statistical values between G1 and G3, G4 (p<0.05). The other groups had no difference between the each other (p<0.05); ALP and GGT have no statistical values among different pathological grades of G1, G2, G3, and G4.Conclusion: the inflammatory grade of CHB can be well reflected in CHB HBeAg (+) and HBeAg (-) by ALT, AST, and Alb. ALT and AST have a good clinical directive value to the anti-viral treatment of CHB, which needs close attention. Further research on specific diagnostic criteria should be done.Experiment 2Be objective to study the clinical diagnosis significance of occult CHB through the observation of transhepatic ultrasound-guided biopsy series ultrastructure. Methods: Electron microscopy of transhepatic ultrasound-guided biopsy is taken on 20 patients who are in abnormal liver function and can not be confirmed by clinical serum. Results: 10 out of the 20 patients fall in Pathological Grade G0, and 2 cases (10%) with HBV infection; among the other 10 patients, 9 fall in Pathological Grade G1, 1 fall in G2, 4 cases with HBV infection, and 1case combining HCV infection. This research also shows 12 cases of collagen hyperplasia in portal area and among liver cells at different degree, which present with progressive tendency along with the increase of the Pathological Grade; reduction on mitochondria and 2 cases of mitochondrial crystallization.Conclusion:In the group of HBsAg(+)CHB patients, the ALT, AST, and Alb distinction has the statistical values between G1 and G2, which has a guidance significance on the clinical antiviral therapy. However, further study is needed on the specific diagnosis parameters. Alb is negatively related to the Pathological Grade and can well reflect degree of hepatitis. It has a great value on the clinically confirmed CHB and guidance of antiviral therapy. Transhepatic ultrasound-guided biopsy is a safe and important method of CHB clinical diagnosis. Ultrastructural observation of liver tissue can improve the diagnosis rate of occult CHB so as to reduce the missed diagnosis of chronic viral hepatitis, which has great value on the clinically confirmed CHB. It can be an effective method of CHB diagnosis and research combining the relevant check and research.