慢性丙型肝炎的病理学研究

The histopathology of chronic hepatitis C

为确定丙型肝炎组织病理学特点,本研究观察了68例慢性丙型肝炎(47例慢迁肝,21例轻/中度慢活肝)及32例慢性乙型肝炎(17例慢迁肝,15例慢活肝)。所有丙型肝炎病例均经多项血清学检查(包括 HCV抗体的检测,应用 PCR 技术检测 HCV RNA 等)证实。大部分丙型肝炎病例(50/68)可见不同程度的肝细胞脂肪变,而在乙型肝炎中肝细胞脂肪变相对少见(10/32),程度亦较轻。无论慢迁肝还是慢活肝,丙型肝炎中都常见汇管区显著的淋巴细胞聚集,有时形成淋巴滤泡;肝窦中炎细胞浸润也较乙型肝炎明显,尤其在慢迁肝时,但小叶内肝细胞的变性、坏死常较乙型肝炎轻。这些结果提示,丙型肝炎时肝细胞的损伤可能主要同 HCV 的直接作用有关。

68 liver biopsy specimens from patients with chronic hepatitis C(47 cases with CPH and 21 cases with mild or moderate CAH)and 32 specimens from patients with chronic hepatitis B(17 cases with CPH and 15 cases with CAH)were studied to determine the histopathologic features of hepatitis C. The cases with hepatitis C were confirmed by various serological tests including tests for anti-HCV antibodies and PCR for HCV RNA.Hepatocytic steatosis in variable degree was detected in most of cases(50/68)with hepatitis C,whereas in cases with hepatitis B less spocimens(10/32)showed steatosis,relatively milder.No matter in CPH or CAH more significant lymphoid aggregates,sometimes forming lymphoid follicles,in portal tracts,and more pronounced sinusoidal infiltrates of lymphocytes and Kupffer cell hyperplasia were seen in hepatitis C cases in spite of milder acidophilic degeneration and focal necrosis of hepatocytes in the acini as compared with cases with hepatitis B.It is suggested that in hepatitis C the hepatocellular damage result to a great extent from the direct cytopathic effect of the HCV.