晚期日本血吸虫病患者肝窦病变的观察

Observation on liver sinusoid of the patients with advanced schistosomiasis japonica

目的观察晚期日本血吸虫病(晚血)患者肝窦病变,并探讨其与肝纤维化程度、肝功能的关系。方法26例晚血患者肝活检标本和5例正常肝标本行常规病理染色和天狼猩红染色,进行肝纤维化程度的半定量分析;应用鼠抗人Ⅳ型胶原(C-Ⅳ)单克隆抗体和兔抗人层粘蛋白(LN)多克隆抗体进行免疫组织化学(免疫组化)染色,阳性者进行定量检测;放射免疫法检测血清透明质酸(HA),自动生化分析仪检测肝功能;对其中5例患者和2例正常肝标本进行透射电镜观察。结果肝纤维化程度为Ⅰ级、Ⅱ级和Ⅲ级的患者分别为5、11和10例,晚血患者肝窦壁C-Ⅳ和LN表达增强,并与肝纤维化程度及部分肝功能指标水平相关(P<0.05或P<0.01),与血清HA水平无关(P>0.05)。晚血患者肝窦内皮细胞(SEC)失窗孔及SEC下可见基底膜(BM)的形成,SEC胞浆内出现Weibel、Palade等发现的小体(简称WP小体),肝窦腔内有脱落的肝细胞微绒毛。结论晚血患者肝窦存在病变,与肝纤维化程度及肝功能改变有关。

Objective To observe the changes of liver sinusoid in the patients with advanced schistosomiasis japonica and explore the relationship with hepatic fibrosis and liver function. Methods Liver biopsy specimens were examined pathmorphologically in 26 patients with advanced schistosomiasis japonica and 5 normal specimens to get to know the degree of liver fibrosis by semi-quantity. Immunohistochemistry staining was used to detect the positive results by location and quantity with mouse anti human C-IV monoclonal antibody and rabbit anti human I.N polyclonal antibody. Serum HA was measured by RIA and some liver function indexes were detected by automatic biochemistry analyzer, the ultra microstructure of the fresh specimens of 5 patients and 2 healthy were observed by transmission electron microscope. Results 5, 11 and 10 patients whose degree of liver fibrosis was 1, 2 and 3 were found respectively. The expression of C-Ⅳ and LN in the patients was higher than normal control （P〈0.01） and was correlated positively with the degree of liver fibro- sis and some liver function indexes （P〈0.05 or P〈0.01）. There was not correlated with the level of serum HA （P〉 0.05）. Loss of fenestration, Weibel-Palade bodies in SEC, microvillus of liver cell and the base membrane in liver sinusoids appeared in the patients. Conclusion Pathological changes observed in liver sinusoid correlate with the degree of hepatic fibrosis and the alteration of liver function.