【摘要】目的 评价肝组织学检查对诊断终末期肾病合并病毒性肝炎的临床意义。方法 84例合并慢性乙型肝炎病毒和丙型肝炎病毒感染的终末期肾病患者接受肝穿刺活检术，以半定量积分法评价肝组织炎症和纤维化程度，将其与临床表现、血清学指标进行对比分析。结果 终末期肾病合并肝炎病毒感染者肝组织的炎症活动度与纤维化程度显著相关（P<0.01）；根据临床表现和生化指标诊断病毒性肝炎与组织学诊断的符合率为38.1％；肝组织炎症活动度和纤维化程度不同的患者之间，血清丙氨酸转氨酶、天门冬氨酸转氨酶、白蛋白、总胆红素和凝血酶原活动度均无明显差异（P均>0.05）。结论 对终末期肾病患者而言，肝组织学检查是诊断慢性肝炎并判断肝脏病变程度唯一可靠的指标。

【Abstract】 Objective To evaluate importance of pathologic assay in diagnosis of viral hepatitis in patients with end stage renal disease (ESRD). Methods Eighty-four ESRD patients with hepatitis B or C virus infection were received the percutaneous liver biopsy. The severity of liver inflammation and fibrosis was evaluated by semi-quantity technique. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), and prothrombin activity (PTA) were detected. The correlation between the clinical feature, parameters of blood biochemical test and the liver histopathological data were studied. Results Necroinflammatory activity was significantly associated with the severity of fibrosis (P<0.01). Clinical diagnosis of hepatitis was in accordance with the histological evaluation in 32 cases (38.1%). There is no significant difference in serum levels of ALT, AST, TBIL, ALB and PTA between patients with different severity of liver inflammation and/or fibrosis. Conclusion Liver biopsy is the only reliable method of confirming the presence and assessing the severity of liver disease in patients with ESRD.