乙型肝炎肝硬化基础上慢加急性肝衰竭及失代偿终末期患者肝内细胆管反应特点对比研究

Comparative studies on intrahepatic ductular proliferation between patients with HBVACLF and end-stage of HBV-associated liver cirrhosis

目的比较乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)及乙型肝炎肝硬化终末期患者肝组织内胆管增生的特点。方法选择20例HBV-ACLF和25例乙型肝炎肝硬化终末期患者移植前肝脏的病理标本,制成石蜡切片后进行HE染色和细胞角蛋白-7(CK-7)单克隆抗体免疫组织化学染色,显微镜下观察肝组织病理形态并作对比分析。结果 HBV-ACLF组在大块或亚大块坏死带四周的汇管区有大量CK-7阳性的细胆管增生并向坏死带中心扩延,在增生的细胆管中可见较多已分化的中间型肝细胞。乙型肝炎肝硬化终末期组的肝组织内可见少量细胆管环绕在肝硬化结节表面,在灶状炎症坏死区域可见局部轻度的细胆管增生,中间型肝细胞则罕见或少见。结论 HBV-ACLF组和乙型肝炎肝硬化终末期组患者肝组织胆管增生的表现形式截然不同,进一步阐明了二者肝组织病理学改变的差异。

Objective To compare the characteristics of intrahepatic ductular proliferation in patients with hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF） and end-stage of HBV-associated liver cirrhosis. Methods Select liver pathological specimens from 20 cases of HBV-ACLF and 25 cases of hepatitis B liver cirrhosis patients with end-stage before liver transplantation were obtained and made into paraffin slides. Then HE staining and anti-cytokeratin-7 （CK-7） immunohistochemistry staining were carried out, followed by morphological observation and comparative analysis. Results In liver samples from HBV-ACLF group, we observed a large number of CK-7 positive proliferating ductules, extruding into the center of necrotic zone around portal tracts in the peripheral of massive or submassive necrotic zone. And we clearly recognized differentiated intermediate hepatocytes; while in end-stage of HBV-associated liver cirrhosis group, we found a small amount of proliferating ductules encircling the surface of cirrhotic nodules and focal ductular reaction around focal inflammatory necrotic area, and intermediate hepatocytes were rarely found. Conclusions Ductular proliferation of HBV-ACLF and end-stage of HBV-associated liver cirrhosis patients displayed disparate patterns, which furtherly clarifies the distinction in liver pathology between the two groups.