肝脏微循环障碍在慢性乙型肝炎中的作用及其发生机制

Pathogenesis and Effects of Hepatic Microcirculation Disorders in Chronic Hepatitis B

目的 :探讨肝脏微循环障碍的发生机制及其在慢性乙型肝炎 (慢乙肝 )病情发展中的作用。方法 :40例慢乙肝患者均行肝活检 ,活检组织分别进行HE染色、免疫组化染色及电镜观察。同时常规检查肝脏功能。结果 :40例慢乙肝患者均存在不同程度的肝脏微循环障碍 ,其中 2 3例肝窦内皮细胞胞浆内可见WP小体。 40例中vWF沿肝窦壁呈阳性表达的有 2 5例 ,肝细胞内HBcAg阳性表达 17例。vWF与HBcAg同时表达者肝功能均不正常。 2 8例肝功异常者中有9例肝细胞内无HBcAg表达 ,但vWF为阳性表达。结论 :慢乙肝存在肝脏微循环障碍 ;肝脏微循环障碍可协同乙肝病毒对肝细胞的免疫损伤 ,从而影响肝脏功能 ;肝窦内皮细胞中WP小体的出现可能是导致肝脏微循环障碍的重要环节。

Objective: To discuss the pathogenesis of hepatic microcirculation disorders in chronic hepatitis B and its effects on the progress of illness.Method: All the liver tissues were obtained by liver biopsy,and stained with hematoxylin-eosin and immunohistochemistry.Hepatic ultrastructures were observed with transmission electron microscope.Results: 40 cases under study all existed hepatic microcirculation disorders with various degrees.There were 23 cases with WP bodies in hepatic sinusoidal endothelial cells and 25 cases with positive expression of vW factor along sinusoidal wall.In those 25 cases,9 cases had abnormal liver function,with negative expession of HBcAg.Conclusion: Hepatic microcirculation disorders exist in patients with chronic hepatitis B.Cooperated with the immunologic injury caused by HBV,hepatic microcirculation disorders can also affect the liver function.The appearance of WP bodies in sinusoidal endothelial cells may play a key role during the development of hepatic microcirculation disorders.