肝内HDAg阳性的慢性丁型肝炎的临床病理探讨

Clinicopathological Characteristics of Chronic Type D Hepatitis■ with Intrahepatic HDAg

对肝内HDAg阳性的慢性丁型肝炎患者临床资料分析表明:若慢性乙肝患者突然出现急性肝炎样表现或反复发作,并且病情进行性发展为肝硬化者,应考虑合并丁型肝炎病毒感染的可能;患者肝内HDAg持续阳性,常预后不良。免疫病理资料提示:HDAg阳性肝细胞周围常不能见到炎性细胞,尤其是淋巴细胞的包绕;部分含HDAg肝细胞,特别胞浆型的阳性细胞可呈气球样变性或萎缩或坏死,似支持HDV具有直接致病作用的观点。

The evidence from assessing the clinicopathological information of chronic type D hepatitis with intrahepatic HDAg expression indicates that the possibility of being superinfected with HDV should be considered, if the patients with chronic hepa-,titis B acutely exacerbate, have repeated ALT rises and [icterus, or rapidly progress to cirrhosis. The persistent HDAg positivity in liver mostly implies a bad prognosis. Interestingly,infiltrate of monocytcs around hepatocytes containing HDAg could hardly be found in contrast to that of hepatocytes expressing HBsAg and HBcAg. Moreover, liver cells with HDAg may undergo balloning, and shrinking or neerostizing change. All above findings seem to support the viewpoint that HDV may be cytopathic.