肝活检在慢性丙型肝炎患者预后判断中的意义研究

Significance of Liver Biopsy (LB) for the Prognosis of the Patients with Chronic Hepatitis C

目的观察慢性丙型肝炎肝活检组织学变化和CD34、CD31、Ki-67蛋白表达,探讨其对慢性丙型肝炎进展至肝硬化、肝癌的预测价值。方法慢性丙型肝炎肝活检患者73例。所有活检标本行HE染色、Azan-Marroy和PAS染色,根据Knodell肝组织活动指数评分系统进行定量评分。标本同时行CD34、CD31、Ki-67免疫组织化学染色,半定量评分系统评价染色结果。随访所有患者。结果 73例慢性丙型肝炎患者随访至少3年,进展至失代偿肝硬化9例、肝细胞肝癌4例。进展至肝硬化或肝癌患者与非进展患者组织学指标(炎症程度分级、纤维化程度分期、肝组织学活动指数评分)比较差异均无统计学意义(P均>0.05);慢性丙型肝炎组织中炎症程度分级与纤维化程度分期呈正相关。73例慢性丙型肝炎的CD34指数为(7.1±5.7),进展至肝硬化或肝癌患者CD34指数明显高于非进展者〔(10.5±7.7)vs(6.4±5.0),P<0.05〕;CD34高表达组肝硬化、肝癌累积发生率明显高于CD34低表达组(P<0.05)。73例慢性丙型肝炎几乎不表达CD31。进展至肝硬化或肝癌患者与非进展者Ki-67指数分别为(5.5±7.2)、(4.5±6.6),两组Ki-67染色阳性率分别为76.92%和61.67%,两组比较差异无统计学意义(P>0.05);Ki-67阳性及阴性表达组肝硬化、肝癌累积发生率间差异无统计学意义(P>0.05)。受试者工作特征(ROC)曲线分析,CD34指数、Ki-67指数、肝组织学活动指数评分在慢性丙型肝炎进展至肝硬化、肝癌过程中的预见优势依次为:CD34指数>Ki-67指数>肝组织学活动指数评分。结论 CD34阳性血窦内皮细胞标记的血管生成是慢性丙型肝炎疾病进展及预后判断的重要因子。

Objective To observe the histological change of Liver Biopsy（LB） and protein expression of CD-34,CD-31 and Ki-67 to investigate its value in predicting liver cirrhosis and liver neoplasms developed from chronic hepatitis C.Methods 73 patients with chronic hepatitis C who had undergone liver biopsy were involved in this study.All specimens were stained with HE,Azan-Marroy,PAS and were graded according to Histological activity index （HAI）.Meanwhile,the CD-34,CD-31,Ki-67 of all specimens were stained immunohistochemically.Semi quantity score system was used to analyze the results.All patients were follow-up surveyed.Results 73 patients with chronic hepatitis C were follow-up surveyed for at least three years,of whom 9 patients have developed into decompensate cirrhosis,4 patients have developed into hepatocellular carcinoma.There is no significant difference in histological parameters （inflammation level,fibrosis staging,histology activity index score） between patients who have developed liver cirrhosis and hepatocellular carcinoma and those who have not （P0.05 respectively）.There is a positive correlation between the inflammation level and the fibrosis staging in chronic hepatitis C,namely when the inflammation level increases,the fibrosis level increases as well.CD-34 LI of 73 patients with chronic hepatitis C is （7.1±5.7）,and CD-34 LI of patients who have developed liver cirrhosis and hepatocellular carcinoma is significantly higher than those who have not〔（10.5±7.7） v （6.4±5.0）,P0.05〕.Control study suggests that incidence of liver cirrhosis and hepatocellular carcinoma is significantly higher in groups with high expressed CD-34 than in groups with low expressed CD-34（P0.05）.CD-31 expression is negative in 73 patients with chronic hepatitis C.KI-67 LI of patients who have developed liver cirrhosis or hepatocellular carcinoma and those who have not are （5.5±7.2）,（4.5±6.6） respectively,and their positive rate for KI-67 are 76-92% and 61-67% respectively,the difference between the two groups is not significant（P0.05）.The incidence difference of liver cirrhosis and hepatocellular carcinoma is not significant between groups with positive KI-67 expression and groups with negative expression （P0.05）.ROC curve suggests that in the development process from chronic hepatitis C to liver cirrhosis and hepatocellular carcinoma,the predictive value should be：CD-34 LIKI-67 LIliver histology activity index.Conclusion The angiogenesis of CD-34 positive sinusoidal endothelial cell is a significant factor in the development and prognosis of chronic hepatitis C.