急性丙型肝炎的临床病理学研究

A study on clinical pathology of acute hepatitis C

对２０例经血清病原学确诊的急性丙型肝炎肝穿病例，进行了临床和病理特征分析。２０例中１８例在发病前２０～１２０天内有手术输血史．临床症状、ＡＬＴ水平，与潜伏期及输血量无明显相关。病理改变主要为小叶及汇管区炎症，纤维化不明显。较特征的改变有：①以大泡脂变为特征的肝细胞“片状变性区”；②窦淋巴细胞渗出较显著，以Ｔ细胞为主；③坏死灶较小，局部炎细胞较多，嗜酸小体易见；④汇管区淋巴细胞聚集；⑤小胆管损伤。其中“片状变性区”及明显的窦淋巴细胞渗出，在病程１月内症状较重者更显著；汇管区淋巴细胞聚集及小胆管损伤与病程无明显相关，不宜作为慢性标志。

Clinical and pathological findings in 20 patients with acute hepatitis C were described. 18 of them received blood transfusions in the past 20～120 days. Their clinical symptoms , ALT levels and latent periods are notrelated to the amount of blood transfusion. All patients were seropositive in anti-hepatitis C virus(HCV) assay and/or positive for HCV RNA by RT-PCR. The main morphological changes were as follow: ① Focal degeneration of liver cells, including large and small droplet fatty changes. ② Focal necrosis and acidophilic body usually being surrounded by T lymphocytes. ③ Sinusoidal inflammatory cell infiltration. ④Lymphocytic aggregations at portal areas. ⑤ Damage of small bile duct. The focal degeneration of liver cells , the lymphocytic aggregations at portal areas and small bile duct damage might be the diagnostic clues for acute hepatitis C.