中文摘要：

目的探讨CHB合并肺结核患者与CHB患者的肝组织病理学差异。方法选择2009年1月至2014年12月住院的CHB合并活动性肺结核初治患者（合并感染组）79例，随机选取同期住院的CHB患者（cHB组）79例。参照Ishak评分系统进行组织学评分，比较两组患者的肝组织炎症活动度分级及纤维化分期。方差齐时两组比较采用t检验，方差不齐时采用Mann—Whitney U检验，两样本率的比较采用χ^2检验。结果合并感染组患者肝组织炎症活动度分级≥G2者为59例，占74．7％，CHB组为47例，占59．5％，差异有统计学意义（χ^2=4．128，P=0．042）。合并感染组患者纤维化分期≥S2者为41例，占51．9％，CHB组为35例，占44．3％，差异无统计学意义（χ^2=0．913，P=0．339）。肝组织Ishak评分结果显示，合并感染组碎片状坏死、汇管区炎症积分和总分均高于CHB组，分别为（2．45±1．19）分比（2．05±1．28）分、（2．70±1．22）分比（2．32±1．08）分、（13．16±6．51）分比（11．22±5．72）分，均差异有统计学意义（t值分别为2．055、2．068和1．984，P值分别为0．042、0．040和0．049）；而合并感染组融合性坏死、灶性（点状）溶解性坏死和纤维化与CHB组比较，差异均无统计学意义，分别为（2．60±1．91）分比（2．13±1．68）分（Z=1．137，P=0．257）、（2．35±1．06）分比（2．16±0．86）分（Z=-1．148，P=0．251）、（3．03±1．63）分比（2．45±1．53）分（Z=1．541，P=0．125）。结论CHB合并肺结核患者的肝组织损伤程度比CHB患者严重。

英文摘要：

Objective To investigate the differences of hepatic pathology between the chronic hepatitis B （CHB） with pulmonary tuberculosis patients and CHB patients. Methods Seventy-nine treatment-naive patients with CHB complicated with pulmonary tuberculosis （co-infection group） were collected from January 2009 to December 2014, and 79 CHB patients were selected randomly during the same period as CriB group. Hepatic tissue inflammation and fibrosis between the two groups were compared according to Ishak scoring system. Comparison between two groups were conducted by t test when the variance was equal and Mann-Whitney U test when the variance was unequal. Categorical data were compared by Ze test. Results A total of 59 （74.7%） patients in co-infection group had inflammation≥G2, compared to 59. 5% in the CHB group. The difference between the two groups was statistically significant （χ^2=4.128, P=0.042）. Forty-one （51.9%） patients in co infection group had fibrosis≥S2, compared with 44.3 % in the CHB group. The difference was not statistically significant （χ^2 = 0. 913, P= 0. 339）. Ishak scoring system showed that piecemeal necrosis, portal area inflammation score and total score in co-infection group were all significantly higher than those in CHB group （2.45±1. 19 vs 2.05% 1.28, 2.70±1.22 vs 2.32±1.08, 13.16±6.51 vs 11.22±5.72, respectively） ,with all the differences statistically significant （t = 2. 055, 2. 068 and 1. 984, respectively; P = 0. 042, 0. 040 and 0. 049, respectively）. However, the confluent necrosis in co-infection group was 2.60±1.91 compared to 2.13±1.68 in CHB group （Z=1. 137,P=0. 257）, focal （dot） soluble necrosis was 2.35-＋-1.06 versus 2.16-＋- 0.86 （Z=-1. 148,P=0. 251）, and fibrosis was 3.03±1. 63 versus 2.45±1.53 （Z=1. 541, P= 0. 125）. Conclusion The liver damage ifl co-infection patients is more severe compared with CHB patients.