摘要
目的 观察既往职业献血员慢性丙型肝炎病毒 (HCV)感染者肝脏病理学特征。方法 从 2 5 0名 5年以上抗 丙型肝炎病毒 (HCV)抗体阳性的献血员中筛选出丙氨酸转氨酶 (ALT)异常的丙型肝炎患者 6 6例 ,对其进行肝穿活检病理检查。其中 6 3例按 1995年《病毒性肝炎防治方案 (试行 )》进行分级分期 ,对血清病毒含量 >5 .0Meq ml(bDNA)的 2 0例行NS5免疫组织化学ABC染色观察。结果 病变程度大多较轻 ,炎症活动度G1 4.8% (3 6 3) ,G2 6 3.5 % (4 0 6 3) ,G32 8.6 % (18 6 3) ,G42例。纤维化程度S1 6 0 .3% (38 6 3)、S2 3 4.9% (2 2 6 3) ,S33 .2 % (2 6 3) ,S41例。主要病变为汇管区炎症 :即胆管损伤 (10 0 .0 % ) ,淋巴细胞集聚 (82 .5 % ) ,汇管区周围碎屑坏死、界面肝炎 (89.5 % )。小叶内病变较轻 ,多数组织肝细胞有不同程度疏松样变 ,散在点灶形坏死 ,窦淋巴细胞浸润 ,而桥接坏死 ,脂肪变性较少 ,分别为 12 .3%和 9.2 %。网状纤维染显示肝纤维化特征为汇管区及其周围纤维化和窦周纤维化。 2 0例NS5免疫组织化学染色 ,胆管上皮均高表达。结论 (1)本组病例具有慢性丙型肝炎的基本特征 ,汇管区周围纤维化与窦周纤维化较为普遍 ;但病变相对较轻 ,脂肪变性少见 ,后者可能与患者低铁状态、饮食习惯有关。
Objective To study the pathological features of liver biopsy from long-term blood donors with chronic hepatitis C. Methods From 250 long-term blood donors with positive serum anti-HCV antibody for more than five years, 66 donors with abnormal ALT level were selected and enrolled in this study. Liver biopsy was performed on these cases and the specimens stained with HE, and reticulin. Modified Schemer's classification for grading and staging was used during pathological observation. Twenty biopsies with serum HCV-RNA levels higher than 5.0 Meq/ml (bDNA) were studied immunohistochemically (SABC) for NS5. Results All cases displayed mild pathological changes. Grade 1 (G 1) inflammation was 4.8%(3/63), G 2 63.5%(40/63), G 3 28.6%(18/63), G 4 two case. Stage 1 (S 1) fibrosis was 60.3% (38/63), S 2 34.9%(22/63), S 3 3.2%(2/63), S 4 only one case. The main lesion was periportal inflammation, such as bile duct damage (100.0%), dense lymphoid aggregates (82.5%) and piecemeal necrosis (89.5%). Intralobular injury of hepatocytes was rather mild. Bridging necrosis and steatosis were not common and observed in only 12.3%(8/66) and 9.2%(6/66) respectively. As for fibrosis, proliferation and deposition of collagen were mainly distributed in the portal and perisinusoidal areas. Among 20 specimens with serum HCV-RNA levels higher than 5.0 Meq/ml (bDNA), all bile duct epithelial cells were positive for HCV-NS5 antigen, while hepatocytes in 4 cases were negative. Conclusion (1) The pathological changes in this series show overall similarity with that of patients with posttransfusion hepatitis C. The main damages are portal and periportal inflamation, such as lymphoid aggregates, bile duct damage, piecemeal necrosis, and extensive periportal and perosinusoidal fibrosis. Intralobular damage was mild with occasional steatosis, which may be related to malnutrition, low level of serum iron due to long term donation. (2) Epithilial cells of the bile duct may be of another site for virus replication, thus it is related with bile duct damage and periportal inflammation.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2000年第6期428-431,共4页
Chinese Journal of Pathology
基金
国家科委重大疾病"九五"攻关项目(96-906-08-04)基金资助
关键词
肝炎
丙型
慢性
血液成分输血
Hepatitis C,chronic
Blood component transfusion
