Dubin—Johnson综合征合并慢性乙型肝炎患者脂褐素小体的超微结构特点

Pleomorphism of the myelin-like bodies in the hepatocytes of patients with Dubin-Johnson syndrome complicated with chronic hepatitis B

目的研究Dubin Johnson综合征合并慢性乙型肝炎患者肝细胞脂褐素小体的超微结构特点。方法用透射电子显微镜（简称电镜）对11例DubinJohnson综合征合并慢性乙型肝炎（轻度）患者、5例Dubin—Johnson综合征患者的肝细胞超微结构进行观察，重点观察脂褐素小体的形态及密度。对数据的统计学分析采用Fisher’s精确概率法。结果11例Dubin—Johnson综合征合并慢性乙型肝炎（轻度）患者的肝细胞脂褐素小体形态呈现多形性，电镜下至少有5种形态：“明亮型”（18．2％，2／11）、“网眼型”（9．1％，1／11）、“点状型”（54．5％，6／11）、“不规则型”（9．1％，1／11）和“基本型”（9．1％，1／11）；而未合并慢性乙型肝炎的DubinJohnson综合征患者的肝细胞脂褐素小体形态相对较为单一，为“基本型”（100．0％，5／5）。“基本型”的差异在两组间比较，P=0．0013。两组患者脂褐素小体的密度也不均等，合并慢性乙型肝炎（轻度）患者的肝细胞脂褐素小体密度低，未合并慢性乙型肝炎（轻度）的Dubin Johnson综合征患者肝细胞脂褐素小体密度高。结论Dubin Johnson综合征合并慢性乙型肝炎（轻度）患者肝细胞脂褐素小体形态呈现多形性，含高电子密度物质的比例少；而Dubin—Johnson综合征患者的肝细胞脂褐素小体形态相对较为单一，以色素沉着较重的“基本型”为主，含高电子密度物质的比例多。二者的差别在诊断上可能有一定价值。

Objective To explore characteristics of the myelin-like bodies in the hepatocytes of patients with Dubin-Johnson syndrome （DJS） complicated with chronic hepatitis B （CHB）. Methods ll cases of DJS complicated with CHB and 5 cases DJS without CHB were studied clinicopathologically. The hepatocyte ultrastructure was observed with transmission electron microscope and taken photos. The data were compared and analyzed using Fisher＇s Exact Test. Results Deposition of myelin-like bodies can be observed in the hepatocytes of DJS patients with CHB but can not in DJS patients without CHB. The morphology of pigment varys. The electron density and volume of pigment in DJS patients with CHB can be classified into five types： brights （2/11,18.2%）, reticulation （1/11, 9.1%）, punctiform （6/11, 54.5%）, abnormity （1/11, 9. 1%） and primary type （1/11, 9.1%）. The myelin-like bodies in the hepatocytes of patients with DJS are high density and round with membrance （we named it as primary type） （5/5, 100%）. Conclusions The myelin-like bodies in the hepatocytes of DJS patients with CHB possess special pleomorphism and may have important diagnostic value.