乙型肝炎肝窦病变的免疫组织化学及电镜观察

Immunohistochemical and electron microscopic observation on sinusoidal lesions in hepatitis B

目的 研究乙型肝炎（ ＨＢ） 肝窦病变的免疫组化表达及超微结构变化的病理意义．方法 ＨＢ 肝活检标本３００ 例， 用ＦＮ，ＬＮ，ＣｏⅣ，αＳＭＡ 及ＶＥＧＦ 单克隆抗体作免疫组化（ＳＰ 法） 染色；另对６５ 例按照电镜技术制样，作超微结构观察．结果 ＨＢ 肝窦有狭窄、阻塞、扩张及肝窦毛细血管化４ 种病变． ＡＨＢ 以肝窦狭窄及阻塞较重者占多数（９５ ％ ） ，而ＣＨＢ 则以肝窦扩张及毛细血管化最明显，两者差异显著（ Ｐ＜ ０－０１） ．肝窦狭窄时肝细胞水肿、微绒毛断裂、线粒体畸型、窦内皮细胞增生或损伤，窗孔减少，基膜物质增多，以αＳＭＡ，ＶＥＧＦ 强表达较前者显著（ Ｐ ＜ ０－０１） ． ＦＮ ，ＬＮ，ＣｏⅣ及αＳＭＡ 表达随肝窦扩张程度升降，与ＶＥＧＦ 表达明显不同（ Ｐ＜ ０－０１） ． 肝窦内皮细胞可出芽形成管腔，基膜物质增多而ＶＥＧＦ 则下降．结论 肝窦病变免疫组化及超微结构变化与ＨＢ 演变有关．

AIM To study the pathological significance of immunohistochemical expression and ultrastructural changes in sinusoidal lesions in hepatitis B (HB). METHODS Immunohistochemical (S P method) staining was performed with FN, LN, Co Ⅳ, α SMA and VEGF monoclonal antibodies on 300 cases of biopsies of HB. At the same time, electron microscopic technique was performed on 65 cases for ultrastructural observation. RESULTS There were 4 types of sinusoidal lesions of HB stenosis, obstruction, dilation and sinusoidal capillarization, etc. In AHB, sinusoidal stenosis and obstruction were predominant (95%); while in CHB, those of sinusoidal dilation and capillarization were more significant. There was significant difference between them ( P <0 01). When the sinusoid stenosed, the hepatocytes edematized, microvilli broke, mitochondria deformed, sinusoidal endothelial cells proliferated or injuried, fenestrae decreased, the substances on basilemma increased, and the strong expressions of α SMA , VEGF were more significant ( P <0 01). The expressions of FN, LN, Co Ⅳ and α SMA increased or decreased in accordance with the degrees of sinusoidal dilations, and were significantly different from the expression of VEGF ( P <0 01) . The sinusoidal endothelial cells could germinate and form lumens, their substances of basilemma increased while their VEGF decreased. CONCLUSION Immunohistochemical and ultrastructural changes of sinusoidal diseases are related with the development of HB.