CAJ | 학술논문

目的探讨肝移植术后乙型肝炎复发的病理学特征和鉴别诊断.方法对1例乙型肝炎后肝硬化患者在肝移植术后进行定期肝穿刺组织学检查.结果肝移植术后25 d血中HBsAg、HBeAg和HBV-DNA均转为阴性.然而,术后58 d HBsAg再次阳性.同时肝穿刺组织学检查见肝细胞气球样变并互相融合形成片状坏死,汇管区和门静脉周围出现纤维化,部分肝细胞和肝小管内可见胆汁淤滞,肝细胞呈HBsAg和HBcAg免疫反应阳性.临床特点为胆红素进行性升高,凝血酶原时问逐渐延长,肝脏酶学检查均升高,持续一段时间后迅速下降,顽固性低蛋白血症,同时伴随一般状态的迅速恶化.结论纤维化胆汁淤滞性肝炎是肝移植术后HBV再感染的一种特殊形式,其临床经过凶险,病理学改变具有特异性,与通常的乙型肝炎有显著的不同.
목적 탐토간이식술후을형간염복발적병이학특정화감별진단.방법 대1례을형간염후간경화환자재간이식술후진행정기간천자조직학검사.결과 간이식술후25 d혈중HBsAg、HBeAg화HBV-DNA균전위음성.연이,술후58 d HBsAg재차양성.동시간천자조직학검사견간세포기구양변병호상융합형성편상배사,회관구화문정맥주위출현섬유화,부분간세포화간소관내가견담즙어체,간세포정HBsAg화HBcAg면역반응양성.림상특점위담홍소진행성승고,응혈매원시문축점연장,간장매학검사균승고,지속일단시간후신속하강,완고성저단백혈증,동시반수일반상태적신속악화.결론 섬유화담즙어체성간염시간이식술후HBV재감염적일충특수형식,기림상경과흉험,병이학개변구유특이성,여통상적을형간염유현저적불동.
Objective To explore the pathological features and the differential diagnosis of recurrent HBV after liver transplantation.Methods One case of liver transplantation for HBV cirrhosis was subjected tO liver biopsies on time postoperatively.Results 25 days after liver transplantation,the HBsAg,HgeAg and HBV-DNA of the patient were negative.but the HBsAg was positive again on the day of 58 after liver transplantation.The histopathological examination showed the balloon-like change of hepatocytes with the fragmental necrosis,fibrosis in portal areas and around the portal veins,cholestasis in some of hepatocytes and canalieulus,and a positive of HBsAg and HBcAg with immunohistochemical stain.The clinical features were:progressive increase of hepatic enzymes levels which maintained for some time and then decreased rapidly,stubborn hypoproteinemia in company with the aggregation of general situation of the patients.Conclusions fibrosing cholestatic hepatitis(FCH)is a special type in recurrent infection of HBV after liver transplantation.It had a serious clinical process and specific pathobgical changes which differentiated from the usual HBV.