中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2014年
9期
654-659
,共6页
肝移植%肝炎,乙型%复发%病理学
肝移植%肝炎,乙型%複髮%病理學
간이식%간염,을형%복발%병이학
Liver transplantation%Hepatitis B%Recurrence%Pathology
目的 初步了解肝移植术后乙型肝炎复发患者的临床病理特征.方法 收集12例乙型肝炎复发患者肝移植术后各期临床表现,采用苏木素-伊红染色,HBsAg和HBcAg免疫组织化学染色,HBV DNA原位杂交以及Mallory三色染色方法对各期肝穿刺组织进行检测,总结乙型肝炎复发各期的临床病理特征.数量资料采用相对数表示,乙型肝炎复发后患者生存率采用Kaplan-Meier法计算.结果 乙型肝炎复发后早期临床表现为:HBV复制活跃,肝功能轻到中度异常,病理学表现为轻到中度病毒性肝炎.4例在乙型肝炎复发后缺少有效抗病毒治疗的患者最终进展为淤胆硬化性肝炎,临床表现为:HBV复制活跃,进行性黄疸和肝功能恶化,其病理学表现为:肝细胞结节状再生,肝内胆汁淤积,汇管区广泛纤维化、炎细胞浸润及胆管组织增生.结论 早期及时获得有效抗病毒治疗的乙型肝炎复发患者临床病理表现为轻度肝炎,少数患者可进展为淤胆性肝硬化,值得进一步研究.
目的 初步瞭解肝移植術後乙型肝炎複髮患者的臨床病理特徵.方法 收集12例乙型肝炎複髮患者肝移植術後各期臨床錶現,採用囌木素-伊紅染色,HBsAg和HBcAg免疫組織化學染色,HBV DNA原位雜交以及Mallory三色染色方法對各期肝穿刺組織進行檢測,總結乙型肝炎複髮各期的臨床病理特徵.數量資料採用相對數錶示,乙型肝炎複髮後患者生存率採用Kaplan-Meier法計算.結果 乙型肝炎複髮後早期臨床錶現為:HBV複製活躍,肝功能輕到中度異常,病理學錶現為輕到中度病毒性肝炎.4例在乙型肝炎複髮後缺少有效抗病毒治療的患者最終進展為淤膽硬化性肝炎,臨床錶現為:HBV複製活躍,進行性黃疸和肝功能噁化,其病理學錶現為:肝細胞結節狀再生,肝內膽汁淤積,彙管區廣汎纖維化、炎細胞浸潤及膽管組織增生.結論 早期及時穫得有效抗病毒治療的乙型肝炎複髮患者臨床病理錶現為輕度肝炎,少數患者可進展為淤膽性肝硬化,值得進一步研究.
목적 초보료해간이식술후을형간염복발환자적림상병리특정.방법 수집12례을형간염복발환자간이식술후각기림상표현,채용소목소-이홍염색,HBsAg화HBcAg면역조직화학염색,HBV DNA원위잡교이급Mallory삼색염색방법대각기간천자조직진행검측,총결을형간염복발각기적림상병리특정.수량자료채용상대수표시,을형간염복발후환자생존솔채용Kaplan-Meier법계산.결과 을형간염복발후조기림상표현위:HBV복제활약,간공능경도중도이상,병이학표현위경도중도병독성간염.4례재을형간염복발후결소유효항병독치료적환자최종진전위어담경화성간염,림상표현위:HBV복제활약,진행성황달화간공능악화,기병이학표현위:간세포결절상재생,간내담즙어적,회관구엄범섬유화、염세포침윤급담관조직증생.결론 조기급시획득유효항병독치료적을형간염복발환자림상병리표현위경도간염,소수환자가진전위어담성간경화,치득진일보연구.
Objective To investigate the clinical pathology of recurrent hepatitis B after orthotopic liver transplantation (OLT).Methods The clinical manifestation and hepatic pathological characteristics of 12 patients with recurrent hepatitis B after OLT were examined in this study by using hematoxylin and eosin staining,immunochemical staining of hepatitis B surface antigen and hepatitis B core antigen,tissue in situ hybridization of hepatitis B virus (HBV) DNA,and Mallory's trichrome staining.The survival rate of these OLT patients was assessed by Kaplan-Meier analysis.Results The early stage of recurrent HBV infection in patients with OLT was characterized by active HBV replication and mild-to-moderate inflammation in the liver.Three of the 12 patients who were treated with combination therapy group were carriers of YMDD mutants and all three showed improvement in liver function and hepatic histology after receiving adefovir dipivoxil,instead of lamivudine,in the early stage of recurrent hepatitis B after OLT.Among the patients treated with lamivudine monotherapy,four did not achieve improvement at the early stage of recurrent hepatitis B and developed fibrosing cholestatic hepatitis (FCH).Conclusion Recurrent hepatitis B in patients who underwent OLT was characterized by mild-to-moderate viral hepatitis at the early stage and FCH at the later stage.Effective antiviral intervention at the early stage may reverse recurrent hepatitis B and prevent the disease progression to fatal FCH.
