Child-Pugh分级与肝脏病理改变的相关性研究

Study on correlation between Child-Pugh grading and hepatic pathological changes

目的了解 Chila-Push 分级与肝硬变严重程度的关系。方法我们选择 Child-Pugh A级、B 级病人各6例,手术中对肝脏进行了肉眼观察,并对肝脏标本进行了光镜及电镜检查。结果发现肝脏肉眼观察,在大小,形态,质地等方面无法区分 Child-Pugh A 级与 B 级的差别。光镜检查发现 A 级病人的肝脏纤维化程度多在Ⅰ-Ⅱ级,且肝细胞坏死少。B 级的肝脏纤维化程度多在Ⅲ-Ⅴ级,肝细胞坏死明显。电镜检查证实 B 级的肝脏中 Disse 腔内胶原纤维多并成束状。而 A 级 Disse 腔则以云絮状物为主。肝细胞及 Kupffer 细胞内细胞器的肿胀,变性等变化,B 级要重于 A 级。结论 Child-Pugh 分级法虽选项不多,但确能反映肝脏病变的程度。两者间呈正相关关系。

Objective To elucidate the relationship between Child-Pugh grading and the degree of hep- atic cirrhosis.Method Six patients each with hepatic cirrhosis in Child-Pugh grade A and B were selected.The livers were observed with gross examinations during operation,and the liver specimens were observed with gross ex- aminations and also checked with light and electron microscopies.Results With naked eyes,it was quite difficult to find differences in size,shape and between different Child-Pugh grades.With hght microscopy,hepatic fibrosis of Ⅰ-Ⅱ degrees was commomly seen in Child-Pugh grade A and necrosis of hepatic cells was slight,while fibrosis of Ⅲ-Ⅴ degrees was usually found in grade B and necrosis was severe.With electron microscopy the collagen fib- rils in Disse's spaces were white cloud-like in grade A,while they were band-like in grade B.Of swelling and de- generation of organellae of hepatic and Kupffer cells,they were worse in grade B than in grade A.Conclusion The parameters in Child-Pugh grading are not complex,but they can be used to evaluate the degree of lesions. There is a positive relationship between them.