病毒性肝炎纤维化病理学与血清学的相关性

Correlation of Pathology and Serology of Fibrosis in Patients with Viral Hepatitis

【目的】探讨病毒性肝炎纤维化的病理改变与血清学指标之间的关系。【方法】在彩色B超定位下穿刺取活体肝组织 2 99例 ,作苏木素 伊红 (HE)、网织纤维 (RT)染色 ,显微镜下观察分级、分期。血清标本用放射免疫测定检测透明质酸(HA)、Ⅲ型人前胶原 (HPCⅢ )、IV 型胶原 (IV C)。【结果】慢性肝炎轻度 97例 ,血清学纤维化指标升高不明显。慢性肝炎中度 12 6例 ,血清学纤维化指标均有不同程度升高 ,慢性肝炎重度 2 9例、肝硬化 47例 ,血清学纤维化指标均显著升高。 2 99例慢性病毒性肝炎病理的炎症活动度和纤维化分期与血清学纤维化程度有密切关系。【结论】慢性病毒性肝炎纤维化的病理改变和血清学的变化随临床病情的变化而改变。肝组织活检结合血清学指标的检测在临床上具有较高的诊断价值。

Objective To study the relationship of pathologic changes and serologic markers of fibrosis in patients with viral hepatitis. Methods Liver specimens were obtained by percutaneous needle biopsy under color Doppler ultrasound guidance in 299 patients with viral hepatitis. The specimens were stained by hematoxylin and eosin (HE), Gordon and Sweet's reticulum methods (RT), in order to determine the degree and the stage of pathologic changes with microscopy. Hyaluronic acid(HA), collagen type Ⅳ(Ⅳ-C) and human precollagen type Ⅲ(HPCⅢ)as serum fibrous markers were detected by radioimmunoassay. Results The serum levels serologic markers were slightly increased in 97 patients with mild chronic hepatitis, moderately increased in 126 patients with moderate chronic hepatitis, and significantly increased in 29 severe cases and 47 subjects with cirrhosis. Both the grade of inflammatory activity and the stage of fibrosis were closely related to the levels of serum fibrous markers. Conclusion Chronic viral hepatitis pathologic feature and levels of serum markers of fibrosis change along with clinical process of patients. The combination of liver biopsy and detection of serum markers of fibrosis might be highly valuable for the diagnosis.