肝移植术后丙型肝炎复发受者肝组织病理学特征分析

Liver histopathological characteristics of recurrent hepatitis C in patients with liver transplantation

目的探讨肝移植术后丙型肝炎复发时受者肝组织病理学特征。方法收集28例明确诊断为肝移植术后丙型肝炎复发患者的54份肝组织病理学资料,回顾性分析丙型肝炎复发时肝组织病理学特点。结果肝移植术后丙型肝炎复发的主要病理学特点是:肝细胞变性和坏死,汇管区以淋巴细胞为主的炎性细胞聚集,以及较早出现的肝纤维化,同时部分病例合并有排斥反应和药物性肝损伤的组织学特点;移植术后远期(大于12 m)丙型肝炎复发者肝纤维化程度较近期(小于12 m)复发者严重[肝纤维化计分为(1.82±1.12)对(1.13±1.08),P<0.05;不同丙型肝炎病毒基因型导致的丙型肝炎在病理学表现上的差异无统计学意义;合并排斥反应及药物性肝损害患者肝炎活动度评分分别为(2.32±0.64)和(2.33±0.88),显著高于无合并组患者(1.64±0.59),(P<0.05)。结论肝移植术后丙型肝炎复发时有特征性的肝脏病理学改变,肝组织病理学检查对移植术后丙型肝炎复发的病情判断具有重要的价值。

Objective To explore the liver histopathological characteristics of recurrent hepatitis C in pa-tients with liver transplantation. Methods 54 liver biopsies were obtained from 28 patients who were diagnosed as recurrent hepatitis C after liver transplantation. Results The main liver pathological features of recurrent hep-atitis C in patients with liver transplantation included liver cell degeneration and necrosis ,lymphocyte and other inflammatory cell aggregation in the portal area,and early occurrence of fibrosis;Besides,liver histopathological features of rejection reaction and drug-induced liver injury were also present in some cases;Liver fibrosis of re-current hepatitis C in late periods （＆gt;12 months） after liver transplantation was significant severe than in patients with recurrent hepatitis C at early periods（the liver staging score were （1.82±1.12） and （1.13±1.08）,respectively, P〈0.05）;No significant differences in pathological manifestations among different viral genotypes of HCV infection were found;Histological activity index in patients with rejection reaction and drug-induced liver injuries were（2.32± 0.64）and （2.33±0.88）,respectively,much higher than that in cases without rejection reaction or drug-induced liver injuries （1.64 ±0.59）,（P〈0.05）. Conclusion Hepatitis C recurrence after liver transplantation has characteristic changes in liver pathology,and liver pathological examination in time might help evaluating the liver injuries of hepatitis C recurrence after liver transplantation.