906例次移植肝穿刺活检病理分析

Pathologic diagnosis of transplantation liver puncture biopsy: clinicopathologic analysis of 906 cases/times

目的对移植肝穿刺活检病理资料进行分析,探讨肝移植后各种并发症的组织形态学表现,为临床诊断和制定治疗方案提供依据。方法对639例肝移植术后发生各种并发症的患者行经皮肝穿刺,取材活检,活检组织行HE染色,部分病例做VanGieson、Masson、过典酸雪夫、网状纤维组织化学染色和免疫组织化学染色,以检测肝组织内乙型肝炎表面抗原、乙型肝炎核心抗原、丙型肝炎抗原、巨细胞病毒早期抗原、巨细胞病毒晚期抗原、巨细胞病毒pp65抗原、EB病毒抗原、细胞角蛋白19的表达。对排斥反应病例,依照国际统一的Banff标准进行分级,应用排斥活动指数(RAI)进行程度评分。结果639例共行肝穿刺906次,结果急性细胞性排斥反应最常见,为386例次(42.61%),其次为胆道并发症,共251例次(27.70%),第三为药物性肝损害,共72例次(7.95%),随后依次为巨细胞病毒感染55例次(6.07%)、肝炎病毒(乙型、丙型)感染及肝炎复发45例次(4.97%)、缺血再灌注损伤42例次(4.64%)、慢性排斥反应32例次(3.53%)、流出道梗阻6例次(0.66%)、原发病复发5例次(0.55%)、移植肝原发无功能4例次(0.44%)和难以诊断8例次(0.88%);与既往资料比较,发现急性细胞性排斥反应的发生率有所下降,而胆道并发症和药物性肝损害的检出率有所升高。结论肝移植术后经皮肝穿刺活组织检查在多种并发症的诊断及鉴别诊断中具有重要价值,可为制定并发症的治疗方案提供重要依据。

Objective To explore the histological morphological features of complications following liver transplantation. Methods In 639 patients with complications following liver transplantation, the percutaneous liver biopsy tissues were stained by HE method. Van Gieson, Masson, PAS, reticulin and immunohistochemical staining were performed. HBsAg, HBcAg, HCVAg, CMV-EA, CMV-LA, CMV pp65, EBVAg and the expression of CK19 were detected. The rejection was graded according to Banff standard and scored with RAI. Results 906 times of liver biopsies in 639 cases were performed. Acute cellular rejection （ACR） was most commonly seen in 386 cases （42.61% ）, followed by complication of biliary tract （251 cases, 27. 70 %）, drug-induced liver damage （72 cases, 7. 95 %）, CMV infection （55 cases, 6. 07 %）, infection or recurrence of hepatitis virus （B or C） （45 cases, 4. 97 % ）, ischemia-reperfusion injury （42 cases, 4. 64 % ）, chronic rejection （32 cases, 3. 53 %）, obstruction of efferent tract （6 cases, 0. 66 %）, recurrence of the primary affection （5 cases, 0.55 G）, and non-function of live grafts （4 cases, 0.44 %）. The complications in 8 cases were difficult to diagnose （0.88 %）. Compared with the previous report of complications, the incidence rate of ACR was decreased and that of complication of biliary tract and dru^induced liver damage in creased in this study. Conclusion Percutaneous liver biopsy is valuable for the diagnosis of complica- tions. It provides the evidence of settling plan of treatment and improves the survival rate.