慢性肝炎肝组织内血管病变与肝纤维化及肝硬化的关系

Relations between hepatic vascular lesions and hepatic fibrotic and cirrhotic changes in chronic hepatitis

目的研究慢性肝炎肝组织中血管病变与肝纤维化及肝硬化的关系。方法1047例慢性乙型肝炎肝活检标本，连续切片分别作HE及网状、胶原、弹力纤维组化染色，光镜观察肝组织病理分级及其中血管炎症、增生、破坏及阻塞四种病理改变与肝组织纤维化程度（分期）的关系。结果①分期与分级相关，炎症、坏死较重者（分级较高）其纤维化程度（分期）亦较高（P＜0．005）。②血管病变与肝组织的炎症、坏死及纤维化相关，即血管病变较重者肝组织分级和分期亦较高（P＜0．05）。③重度血管破坏及阻塞只见于S3及s4组，但前者在这两组分布无差异，而后者以S4（肝硬化）组较多（P＜0.05）。结论①慢性肝炎肝组织血管病变与肝组织病理学的炎症、坏死和纤维化相伴发生。③重度血管阻塞可能是肝硬化的重要原因之一。

Objective To explore the relationship between hepatic vascular lesions and hepatic fibrotic and cirrhotic changes in chronic hepatitis. Methods 1047 liver biopsy specimens from patients with chronic hepatitis B were examined by light microscopy. The specimens were stained with routine HE technique for histopathologic gradings, histochemical techniques for reticulin,collagen and elastic fibers. Attention was focused on the relationships between gradings of hepatic histopathology and the inflammatory, proliferative, destructive and occlusive changes to the degree of fibrosis (staging). Results ①Staging was positively correlated with grading, the more the inflammation and necrosis, the severer the fibrosis (P<0.005). ②So did the vascular lesions with the grading and staging (P<0.05). ③Severe damage and vascular occlusions were only seen in S, and S4, and there was no significant differences in distribution of the former in S3 and S4,whereas it was virtual in the latter (P<0.05). Conclusion ①The vascular lesions in the hepatic tissue of chronic hepatitis parallel the parenchymal inflammation,necrosis, and fibrosis. ②Vascular occlusion may be one of the main causes of hepatic cirrhosis.