Budd-Chiari综合征%高血压,门静脉%肝硬化%病理学
Budd-Chiari綜閤徵%高血壓,門靜脈%肝硬化%病理學
Budd-Chiari종합정%고혈압,문정맥%간경화%병이학
Budd-Chiari syndrome%Hypertension,portal%Liver cirrhosis%PathoIogy
目的 对比研究布加综合征( Budd-Chiari syndrome,BCS)和肝内型门静脉高压症(intrahepatic portal hypertension,IPH)患者手术前后肝脏组织病理学变化的特征.方法 自2010年1月至12月,于患者行分流术中分别取肝脏组织活检(即术前,其中BCS患者9例,IPH患者4例),术后6～9个月行肝穿刺取肝组织,利用免疫组化方法测定肝组织术前和术后肝脏Ⅳ型胶原(collagentypeⅣ,ColⅣ)、Ⅲ型前胶原(procollagenⅢ,PCⅢ)、基质金属蛋白酶1(matrix metalloproteinase,MMP-1)和基质金属蛋白酶抑制因子1(tissue inhibitors of metalloproteinase,TIMP-1)的表达情况,并行HE染色观察肝组织形态学.术中测量分流前后自由门静脉压力(free portal vein pressure,FPP)变化,并将其与肝脏纤维化程度进行相关分析.结果 BCS组手术后与手术前相比,PCⅢ、ColⅣ和TIMP-1的表达均呈下降趋势[(127±15)比(137±16),t =4.896,P=0.013；(115.2±10.6)比(127.3±9.5),t =4.877,P=0.003；(119.2±11.3)比(131.2±19.6),t=2.841,P=0.023],手术前后MMP-1表达相比差异无统计学意义(P＞0.05),MMP-1/TIMP-1比值与肝纤维化程度未呈现出相关[(0.95±0.16)比(0.98±0.15),t=-0.710,P=0.504].IPH组在手术前后上述4项指标表达相比差异无统计学意义(均P＞0.05).术前BCS组PCⅢ、ColⅣ及TIMP-1表达与IPH组相比差异无统计学意义(均P＞0.05),术后BCS组上述指标下降比IPH组明显[(127±15)比(150±12),U=3.000.P=0.038；(115.2±10.6)比(128.1±2.8),U=2.000,P=0.023；(119.2±11.3)比(131.4±2.5),U=3.000,P=0.038].HE染色结果显示:BCS组术前为淤血性,术后肝脏病变减轻.IPH组在手术前后肝组织病理相比无明显变化.BCS组及IPH组在分流后FPP均明显下降[(25±8)比(41±8) cm H2O,=17.816,P=0.000；(31±8)比(45±9) cmH2O,t =5.745,P=0.010].结论 BCS通过解除梗阻缓解压力,其肝脏病理学呈现明显的可逆性改变；IPH在分流术后压力虽然得到缓解,但肝脏病理学改变没有明显的改善.
目的 對比研究佈加綜閤徵( Budd-Chiari syndrome,BCS)和肝內型門靜脈高壓癥(intrahepatic portal hypertension,IPH)患者手術前後肝髒組織病理學變化的特徵.方法 自2010年1月至12月,于患者行分流術中分彆取肝髒組織活檢(即術前,其中BCS患者9例,IPH患者4例),術後6～9箇月行肝穿刺取肝組織,利用免疫組化方法測定肝組織術前和術後肝髒Ⅳ型膠原(collagentypeⅣ,ColⅣ)、Ⅲ型前膠原(procollagenⅢ,PCⅢ)、基質金屬蛋白酶1(matrix metalloproteinase,MMP-1)和基質金屬蛋白酶抑製因子1(tissue inhibitors of metalloproteinase,TIMP-1)的錶達情況,併行HE染色觀察肝組織形態學.術中測量分流前後自由門靜脈壓力(free portal vein pressure,FPP)變化,併將其與肝髒纖維化程度進行相關分析.結果 BCS組手術後與手術前相比,PCⅢ、ColⅣ和TIMP-1的錶達均呈下降趨勢[(127±15)比(137±16),t =4.896,P=0.013；(115.2±10.6)比(127.3±9.5),t =4.877,P=0.003；(119.2±11.3)比(131.2±19.6),t=2.841,P=0.023],手術前後MMP-1錶達相比差異無統計學意義(P＞0.05),MMP-1/TIMP-1比值與肝纖維化程度未呈現齣相關[(0.95±0.16)比(0.98±0.15),t=-0.710,P=0.504].IPH組在手術前後上述4項指標錶達相比差異無統計學意義(均P＞0.05).術前BCS組PCⅢ、ColⅣ及TIMP-1錶達與IPH組相比差異無統計學意義(均P＞0.05),術後BCS組上述指標下降比IPH組明顯[(127±15)比(150±12),U=3.000.P=0.038；(115.2±10.6)比(128.1±2.8),U=2.000,P=0.023；(119.2±11.3)比(131.4±2.5),U=3.000,P=0.038].HE染色結果顯示:BCS組術前為淤血性,術後肝髒病變減輕.IPH組在手術前後肝組織病理相比無明顯變化.BCS組及IPH組在分流後FPP均明顯下降[(25±8)比(41±8) cm H2O,=17.816,P=0.000；(31±8)比(45±9) cmH2O,t =5.745,P=0.010].結論 BCS通過解除梗阻緩解壓力,其肝髒病理學呈現明顯的可逆性改變；IPH在分流術後壓力雖然得到緩解,但肝髒病理學改變沒有明顯的改善.
목적 대비연구포가종합정( Budd-Chiari syndrome,BCS)화간내형문정맥고압증(intrahepatic portal hypertension,IPH)환자수술전후간장조직병이학변화적특정.방법 자2010년1월지12월,우환자행분류술중분별취간장조직활검(즉술전,기중BCS환자9례,IPH환자4례),술후6～9개월행간천자취간조직,이용면역조화방법측정간조직술전화술후간장Ⅳ형효원(collagentypeⅣ,ColⅣ)、Ⅲ형전효원(procollagenⅢ,PCⅢ)、기질금속단백매1(matrix metalloproteinase,MMP-1)화기질금속단백매억제인자1(tissue inhibitors of metalloproteinase,TIMP-1)적표체정황,병행HE염색관찰간조직형태학.술중측량분류전후자유문정맥압력(free portal vein pressure,FPP)변화,병장기여간장섬유화정도진행상관분석.결과 BCS조수술후여수술전상비,PCⅢ、ColⅣ화TIMP-1적표체균정하강추세[(127±15)비(137±16),t =4.896,P=0.013；(115.2±10.6)비(127.3±9.5),t =4.877,P=0.003；(119.2±11.3)비(131.2±19.6),t=2.841,P=0.023],수술전후MMP-1표체상비차이무통계학의의(P＞0.05),MMP-1/TIMP-1비치여간섬유화정도미정현출상관[(0.95±0.16)비(0.98±0.15),t=-0.710,P=0.504].IPH조재수술전후상술4항지표표체상비차이무통계학의의(균P＞0.05).술전BCS조PCⅢ、ColⅣ급TIMP-1표체여IPH조상비차이무통계학의의(균P＞0.05),술후BCS조상술지표하강비IPH조명현[(127±15)비(150±12),U=3.000.P=0.038；(115.2±10.6)비(128.1±2.8),U=2.000,P=0.023；(119.2±11.3)비(131.4±2.5),U=3.000,P=0.038].HE염색결과현시:BCS조술전위어혈성,술후간장병변감경.IPH조재수술전후간조직병리상비무명현변화.BCS조급IPH조재분류후FPP균명현하강[(25±8)비(41±8) cm H2O,=17.816,P=0.000；(31±8)비(45±9) cmH2O,t =5.745,P=0.010].결론 BCS통과해제경조완해압력,기간장병이학정현명현적가역성개변；IPH재분류술후압력수연득도완해,단간장병이학개변몰유명현적개선.
Objective To compare liver pathology changes of patients with Budd-Chiari syndrome (BCS) and intrahepatic portal hypertension (IPH) after portosystemic shunt surgery. Methods From January 2010 to December 2011,liverbiopsy was taken during shunt surgery (9 BCS patients,4 IPH patients),and 6-9 months after surgery on follow-up.Collagen type Ⅳ ( Col Ⅳ ),procollagen m (PC Ⅲ ),matrix metalloproteinase (MMP-1),tissue inhibitors of metalloproteinase(TIMP-1) were tested using SABC (immuonohistochemistry) method,and HE staining to observe the morphology of liver tissue.Free portal vein pressure before and after shunt was measured. Results In BCS group,Col Ⅳ,PC 1Ⅲ and TIMP-1expression downregulated after surgery (127 ±15) vs.(137 ±16),t =4.896,P-0.013; (115.2 ± 10.6) vs.(127.3±9.5),t=4.877,P=0.003; (119.2±11.3) vs.(131.2±l9.6),t=2.841,P=0.023.MMP-1expression did not change ( P ＞ 0.05 ),while MMP-1/TIMP-1was not significantly correlated with liver fibrosis (0.95 ±0.16) vs.(0.98 ±0.15),t =-0.710,P =0.504.In IPH group,the expression of Col Ⅳ,PC Ⅲ,MMP-1,and MMP-1/TIMP-1did not change significantly after surgery (P ＞0.05).Compared with that in IPH group the expression of PC Ⅲ,Col Ⅳ and TIMP-1downregulated significantly in BCSgroup (127±15) vs.(150 ±12),U=3.000,P=0.038; (115.2 ±10.6) vs.(128.1±2.8),U=2.000,P=0.023; (119.2 ± 11.3) vs.(131.4 ±2.5),U=3.000,P =0.038.By HE staining in BCS group there was significant intrahepatic congestion which alleviated after surgery.While in PHT group liver pathology did not change significantly after surgery.FPP in BCS and IPH patients significantly decreased after shunt surgery (25 ±8) vs.(41±8) cmH20,t=17.816,P=0.000;(31±8) vs.(45 ±9) cmH20,t =5.745,P =0.010 ). Drop of FPP of BCS group plays a key role in reversal of liver fibrosis.Conclusions In BCS group liver pathology improved after shunt surgery probably by removing the intrahepatic obstruction,but in IPH group liver pathology remained unchanged after shunt.
