e抗原阴性慢性乙型肝炎合并非酒精性脂肪性肝病的病理特征

Study on pathological characteristic in HBeAg negative chronic hepatitis B patients with nonalcoholic fatty liver disease

目的观察HBeAg阴性慢性乙型肝炎合并非酒精性脂肪性肝病患者肝组织病理特征。方法收集72例慢性乙型肝炎合并非酒精性脂肪性肝病患者的肝组织标本及临床相关资料,肝组织标本常规行HE、Masson三色及网状纤维染色,观察其病理改变特点,并进行分级、分期。结果HBeAg阴性慢性乙型肝炎合并非酒精性脂肪性肝病患者肝活检病理学改变以肝细胞脂肪变性为主,肝细胞脂肪变性主要位于腺泡Ⅲ带,呈弥漫分布,重度患者则可扩大至腺泡Ⅱ带甚至全腺泡,轻度患者汇管区炎及界面性炎均不明显,主要为小叶内点灶状坏死,大部分患者仅为血窦壁及中央静脉管壁及周围纤维组织增生,且多为纤细的网状纤维,汇管区纤维组织增生不明显,重度及肝硬化患者则汇管区纤维组织增生显著,彼此相连,破坏正常的肝小叶结构,形成假小叶。结论HBeAg阴性慢性乙型肝炎合并非酒精性脂肪性肝病患者肝组织病理改变具有一定病理学特征;其病理学特征应从炎症、纤维化程度与肝细胞脂肪变性范围、肝细胞损伤等方面综合分析,肝组织活检有助于早期明确诊断,从而指导临床合理治疗。

Objective To investigate pathological characteristic of the liver biopsies in HBeAg negative chronic hepatitis B（CHB） patients with nonalcoholic fatty liver disease （NAFLD）. Methods Pathological and clinical data were collected from 72 patients with HBeAg negative CHB patients and NAFLD. Liver biopsy tissues were graded and examined with HE.Masson and reticular fiber staining. Results Liver biopsy pathology of the HBeAg negative CHB patients with NAFLD is mainly changed by hepatocytes steatosis. The hepatocytes steatosis mainly located in acinar Ⅲ zone with diffused distribution, which is in serious patient may be extended to acinar Ⅱ or to the whole acinar. The inflammation in portal areas and interface is not very clear in slight patients. It is mainly focused on lobular necrosis. Most patients are only sinusoids wall, the central vein wall and the surrounding fibrous tissue proliferated and most of the fiber are tenuous reticular fiber. The fiber tissues proliferation is not clear in portal areas, but it is clear in serious patients and cirrhosis patients and it is linked each other to destroy the normal structure of the hepatic lobules to form a pseudolobule. Conclusion The liver tissues histology in the HBeAg negative CHB patients with NAFLD possess some pathology characters. It should be analyzed from inflammation, the extent of the fibrosis, the hepatocytes and damage steatosis area. The liver biopsy is helpful for early diagnosis and clinical reasonable treatment.