丙型肝炎的病理观察

Pathologic observations of Hepatitis C

为确立我国丙型肝炎病理形态学特点，我们观察了７０例经临床确诊的丙型肝炎肝穿标本，其中８９％有输血及血制品使用史。按病程分为急性丙型肝炎２０例，慢性丙型肝炎５０例，其中合并乙型肝炎者７例。与乙型肝炎相比，丙型肝炎特征的组织学改变有：汇管区淋巴细胞集聚、小胆管损伤及较明显的肝细胞脂变。此外，急性丙型肝炎尚见片状的肝细胞明显大小不等，伴大泡脂变。慢性丙型肝炎伴小胆管损伤淋巴细胞集聚，以Ｔ细胞为主，致汇管区扩大为其特征。中度以上慢性活动型丙型肝炎常见宽大的汇管区－汇管区桥接坏死及纤维化，碎屑坏死相对较轻。本研究为丙型肝炎的病理诊断及与乙型肝炎的鉴别诊断提供了依据。

he morphological change;in liver biopsies from 70 patients with a clinical diagnosis of hepatitis C were studied.Sixty-two of the patients had history of blood transfusions.All patients were seropositive for anti-HCV by fir;tand second generation test and/or were seropositive for HCV RNA by PCR method. Clinically,twenty cases were diagnosed as acute hepatitis, fifty were chronic including 7 cases with both HBV and HCV infection. The main morphological changes in acute cases being 1. Focal de-generation of liver cells,including large and small droplet fatty changes. 2.Feeal necrosis and aci-dophilic bodies usually being surrounded by T lymphocytes. 3.Sinusoidal inflammatory cell infiItration.4. Lymphoid aggregation with bile duct epithelial damage was found in 60%of portal tracts. The chronic cases included 17 chronic persistant hepatitis cases (CPH) and 33 chronic active hepatitis cases(CAH).The main histopathologic changes in CAH included dense clusters of lymphocytes ( lymphoid aggregates )present in the enlarged portal tracts with bridging necrosis and fibrosis,lobular inflamma-tion including acidophilic bodies,focal necrosis and fatty degeneration. The sinusoidal cells were often hyperplastic. These changes may provide useful diagnostic clues for hepatitis C.