中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2010年
10期
721-725
,共5页
刘旭华%郑素军%祖可佳%陈煜%陈义森%王泰龄%段钟平
劉旭華%鄭素軍%祖可佳%陳煜%陳義森%王泰齡%段鐘平
류욱화%정소군%조가가%진욱%진의삼%왕태령%단종평
肝炎,乙型,慢性%肝功能衰竭%病理学%荟萃分析
肝炎,乙型,慢性%肝功能衰竭%病理學%薈萃分析
간염,을형,만성%간공능쇠갈%병이학%회췌분석
Hepatitis B,chronic%Liver failure%Pathology%Meta-analysis
目的 观察慢性乙型重型肝炎(CSHB)肝衰竭的临床和病理形态特点.方法 回顾性分析91例CSHB临床和病理资料,按其发病前基础病情分为慢性HBV携带组(HBC)、慢性乙型肝炎组(CHB)和肝硬化组(LC),分析各组患者出现肝衰竭的类型、临床特点和病理特点.结果 91例CSHB患者中,男性74例,女性17例,平均年龄(40.6±11.2)岁,发生在HBC者9例(9.9%)、CHB者7例(7.7%)、LC者75例(82.4%).平均年龄在HBC组为(25.8±6.6)岁、CHB组为(36.9±9.0)岁、LC组为(42.0±10.5),HBC组平均年龄较CHB组和LC组小,P值分别为0.032和0.001.各组患者肝衰竭类型均以哑急性为主,发生肝衰竭时间为15～150d,平均(42.2±30.6)d,以黄疸深、腹水为突出特点.常见诱因为劳累、重叠感染、病毒变异、应用肝损伤药物及饮酒.各组CSHB患者的凝血酶原时间、活动度和总胆红素差异无统计学意义.白蛋白、胆碱酯酶在LC组分别为(30.3±5.1)g/L和(2926.8±1471.1)U/L、HBC组分别为(35.6±5.1)g/L和(4363.5±2063.2)U/L、CHB组分别为(37.4±5.0)g/L和(5167.1±1522.1)U/L,LC组白蛋白、胆碱酯酶均明显低于HBC组和CHB组,F值分别为9.450和9.297,P值均＜0.01.胆固醇LC组为(1.8±1.0)mmol/L、HBC组为(2.9±1.0)mmol/L,LC组低于HBC组,P=0.034,差异有统计学意义.HBV DNA定量HBC组为(6.8±1.7)log10拷贝/ml、LC组为(4.2±2.6)log10拷贝/ml,HBC组高于LC组,P=0.019,差异有统计学意义.HBC和CHB基础上的CSHB肝脏病理表现主要为大块或亚大块坏死,病变较均匀,与急性/亚急性重型肝炎的病理特点并无显著区别,CHB基础上的CSHB,出现广泛坏死时极易掩盖原有病变,Masson染色可显示汇管区周围纤维化.肝硬化基础上者病变不均一,大块或亚大块坏死的同时总有部分结节保留,不同部位坏死范围及新旧程度不一.结论 我国CSHB多发生于肝硬化基础上,其病理特征与慢加急/亚急性肝衰竭相对应,而发生在HBC和CHB基础上的CSHB,其病理特征与急性或亚急性肝衰竭类似.
目的 觀察慢性乙型重型肝炎(CSHB)肝衰竭的臨床和病理形態特點.方法 迴顧性分析91例CSHB臨床和病理資料,按其髮病前基礎病情分為慢性HBV攜帶組(HBC)、慢性乙型肝炎組(CHB)和肝硬化組(LC),分析各組患者齣現肝衰竭的類型、臨床特點和病理特點.結果 91例CSHB患者中,男性74例,女性17例,平均年齡(40.6±11.2)歲,髮生在HBC者9例(9.9%)、CHB者7例(7.7%)、LC者75例(82.4%).平均年齡在HBC組為(25.8±6.6)歲、CHB組為(36.9±9.0)歲、LC組為(42.0±10.5),HBC組平均年齡較CHB組和LC組小,P值分彆為0.032和0.001.各組患者肝衰竭類型均以啞急性為主,髮生肝衰竭時間為15～150d,平均(42.2±30.6)d,以黃疸深、腹水為突齣特點.常見誘因為勞纍、重疊感染、病毒變異、應用肝損傷藥物及飲酒.各組CSHB患者的凝血酶原時間、活動度和總膽紅素差異無統計學意義.白蛋白、膽堿酯酶在LC組分彆為(30.3±5.1)g/L和(2926.8±1471.1)U/L、HBC組分彆為(35.6±5.1)g/L和(4363.5±2063.2)U/L、CHB組分彆為(37.4±5.0)g/L和(5167.1±1522.1)U/L,LC組白蛋白、膽堿酯酶均明顯低于HBC組和CHB組,F值分彆為9.450和9.297,P值均＜0.01.膽固醇LC組為(1.8±1.0)mmol/L、HBC組為(2.9±1.0)mmol/L,LC組低于HBC組,P=0.034,差異有統計學意義.HBV DNA定量HBC組為(6.8±1.7)log10拷貝/ml、LC組為(4.2±2.6)log10拷貝/ml,HBC組高于LC組,P=0.019,差異有統計學意義.HBC和CHB基礎上的CSHB肝髒病理錶現主要為大塊或亞大塊壞死,病變較均勻,與急性/亞急性重型肝炎的病理特點併無顯著區彆,CHB基礎上的CSHB,齣現廣汎壞死時極易掩蓋原有病變,Masson染色可顯示彙管區週圍纖維化.肝硬化基礎上者病變不均一,大塊或亞大塊壞死的同時總有部分結節保留,不同部位壞死範圍及新舊程度不一.結論 我國CSHB多髮生于肝硬化基礎上,其病理特徵與慢加急/亞急性肝衰竭相對應,而髮生在HBC和CHB基礎上的CSHB,其病理特徵與急性或亞急性肝衰竭類似.
목적 관찰만성을형중형간염(CSHB)간쇠갈적림상화병리형태특점.방법 회고성분석91례CSHB림상화병리자료,안기발병전기출병정분위만성HBV휴대조(HBC)、만성을형간염조(CHB)화간경화조(LC),분석각조환자출현간쇠갈적류형、림상특점화병리특점.결과 91례CSHB환자중,남성74례,녀성17례,평균년령(40.6±11.2)세,발생재HBC자9례(9.9%)、CHB자7례(7.7%)、LC자75례(82.4%).평균년령재HBC조위(25.8±6.6)세、CHB조위(36.9±9.0)세、LC조위(42.0±10.5),HBC조평균년령교CHB조화LC조소,P치분별위0.032화0.001.각조환자간쇠갈류형균이아급성위주,발생간쇠갈시간위15～150d,평균(42.2±30.6)d,이황달심、복수위돌출특점.상견유인위로루、중첩감염、병독변이、응용간손상약물급음주.각조CSHB환자적응혈매원시간、활동도화총담홍소차이무통계학의의.백단백、담감지매재LC조분별위(30.3±5.1)g/L화(2926.8±1471.1)U/L、HBC조분별위(35.6±5.1)g/L화(4363.5±2063.2)U/L、CHB조분별위(37.4±5.0)g/L화(5167.1±1522.1)U/L,LC조백단백、담감지매균명현저우HBC조화CHB조,F치분별위9.450화9.297,P치균＜0.01.담고순LC조위(1.8±1.0)mmol/L、HBC조위(2.9±1.0)mmol/L,LC조저우HBC조,P=0.034,차이유통계학의의.HBV DNA정량HBC조위(6.8±1.7)log10고패/ml、LC조위(4.2±2.6)log10고패/ml,HBC조고우LC조,P=0.019,차이유통계학의의.HBC화CHB기출상적CSHB간장병리표현주요위대괴혹아대괴배사,병변교균균,여급성/아급성중형간염적병리특점병무현저구별,CHB기출상적CSHB,출현엄범배사시겁역엄개원유병변,Masson염색가현시회관구주위섬유화.간경화기출상자병변불균일,대괴혹아대괴배사적동시총유부분결절보류,불동부위배사범위급신구정도불일.결론 아국CSHB다발생우간경화기출상,기병리특정여만가급/아급성간쇠갈상대응,이발생재HBC화CHB기출상적CSHB,기병리특정여급성혹아급성간쇠갈유사.
Objective In China, liver failure is also termed as severe hepatitis in whom chronic severe hepatitis B (CSHB) is most common. The aim of this study was to assess whether CSHB based on different liver injury extent can meet the international definition of acute-on-chronic liver failure(ACLF) criteria, according by their clinical and pathological feature. Methods A total of 91 patients with CSHB were involved in the study. The clinical findings, laboratory data and liver pathology features were retrospectively analyzed and grouped by hepatitis virus B carrier state (HBC), chronic hepatitis B (CHB) or liver cirrhosis (LC) before they started liver failure. Results 74 out of the 91 patients were male and 17 were female, the mean age was 40.6 ± 11.2 years. 9.9%, 7.7% and 82.4% of the patients were based on HBC, CHB and LC respectively. The ages of HBC group were youngest. The mean age of HBC group (years) (25.8 ± 6.6) was significantly lower than that of CHB group (36.9 ± 9.0) and LC group (42.0 ± 10.5)with P values of 0.032 and 0.001 respectively. Most cases presented with sub-acute liver failure characterized by high icterus and ascites. Predisposing factors included exertion, superinfection, virus variation, drugs or alcholic injury. No difference found between PTA (F = 0.906, P= 0.408) and TBil (F= 0.839, P = 0.436) among the above three groups. The Alb and CHE levels in LC group were (30.3 ± 5.1) g/L and (2926.8 ± 1471.1) U/L respectively,which were lower than both HBC group [Alb (35.6 ± 5.1) g/L, CHE (4363.5 ± 2063.2) U/L] and CHB group [Alb (37.4 ± 5.0) g/L, CHE (5167.1 ± 1522.1) U/L] (F = 9.450; F = 9.297; P ＜ 0.01).The level of CHO (1.8 ± 1.0) mmol/L in LC group was lower than that of HBC group (2.9 ± 1.0mmol/L, P = 0.034),while serum HBV DNA level of HBC group [(6.8 ± 1.7) log10copies/ml] was higher than that of LC group [(4.2 ± 2.6) log10copies/ml]. The liver tissue in HBC and CHB group showed massive or submassive necrosis which distribute evenly in different parts of liver and similarly in slides, most like acute/subcute severe hepatitis. The chronic lesion was easily covered by extensive necrosis in CSHB based on CHB, with portal fibrosis can be seen by masson stain. Characteristic picture of LC group were massive or submassive necrosis with some nodules were intact or only patchy necrosis of the parenchyma, disparity of extent and stage of necrosis existed in slides, which were the major difference in histopathological change in HBC and CHB group. Conclusion Most of CSHB cases were based on liver cirrhosis, which match with the international definition of ACLF,while small part of CSHB cases based on HBC and CHB are identical to acute/subacute liver failure.
