慢性重型乙型肝炎的病理形态学表现及诊断

Histopathological changes in livers of patients with chronic severe hepatitis B

目的观察并总结慢性重型乙型肝炎（CSHB）的病理形态学特点。方法用常规HE染色、组织化学Masson三色、Sweet网织、D-PAS染色及免疫组织化学CK7、CD68、增殖细胞核抗原染色对42例CSHB病例进行回顾性观察和分析。结果CSHB的基本病变是在慢性肝病的背景上出现大块或亚大块坏死，坏死的特点是部分肝硬化结节坏死，部分肝硬化结节保留，保留的硬化结节仍可发生部分肝细胞坏死。坏死后的肝细胞常被清除，而间质成分保留。随着病程的进展，还表现出不同程度的肝细胞再生和细胆管增生。结论CSHB与急性、亚急性重型乙型肝炎的病变表现是一致的，有其特征性的病理形态学改变，对重型肝炎的诊断应结合病因加以分类。

Objective To investigate the histopathological features in livers of chronic severe hepatitis B （CSHB） patients. Methods Histology of 42 livers was studied. HE, Masson, Sweet and D-PAS staining and cytokeratin 7, CD68 and proliferating cell nuclear antigen immuno-histochemical staining were used in the study. Results In CSHB, the livers showed massive or submassive necrosis in a background of other histological changes of chronic hepatitis B. The characteristic pictures of these livers were necrosis of all the hepatocytes in some nodules, while in other nodnies there were only patchy necroses of the parenchyma. In some other nodules the necrotic hepatocytes were all removed and only the scaffolding stroma remained. Meanwhile, regeneration of hepatocytes and bile ductules were also seen. Contusions The liver histopathological changes in CSHB are identical, but not of the same degree as those of acute severe and subacute severe hepatitis B. In making differential diagnoses for liver aspiration biopsies of these patients, this fact should be kept in mind.