乙肝肝硬化碎屑状坏死病变的ISEL及CK-7、α-sma免疫组化研究

The immunohistochemistry research of ISEL and ck-7 and α-sma in PMN lesion of cirrhosis with HBV infection

目的 探讨碎屑状坏死 (PMN)形态学及其与凋亡关系。方法 随机收集乙肝肝硬化患者 60例 ,其中单纯肝硬化 (A组 )和合并肝癌者 (B组 )各半。做原位末端标记 (ISEL)和CK 7、α sma免疫组化。结果 1 PMN的发生A组远多于B组 ;ISEL(+ )B组远多于A组 ;有PMN的病例其ISEL(+ )仅 5 % ,而无PMN者高达 72 5 %。以上三点均P <0 .0 1。 2 PMN病变中有大量毛细管样胆小管 (capillary likebileductules ,CLBD)增生 ,并有肝细胞间纤维化。结论 PMN病例甚少肝细胞凋亡 ,而无PMN的肝硬化则凋亡相对较多 ;PMN病变到了肝硬化晚期会消失 ;毛细管样胆小管增生和纤维化是PMN的重要改变。

Aim To find the morphological significance of piece meal necrosis (PMN) and its relationship to apoptosis.Methods 60 cases of HBV liver cirrhosis were randomly collected.30 cases were simple cirrhosis(Group A);30 cases were cirrhosis complicated by hepatocellular carcinoma(Group B).All cases were HbsAg(+).In situ end labeling(ISEL) and cytokeratin 7(CK 7),α sma,HBsAg and HBcAg immunohistochemistry were done in all cases.Results 1 Incidence of PMN in Group A was much higher than that in Group B( P<0.01) ;In the PMN Group (20 cases),only 5% were ISEL(+),while in the non PMN Group (40 cases) 72.5% were ISEL(+)( P<0.01 );The ISEL(+) rate in Group B was much higher than that in Group A( P<0.01) .2 In PMN lesions,there were large amount of 'capillary like bile ductules' (CLBD) proliferating (CK 7+) and fibrosis(α sma+) just around the hepatocytes.Conclusions PMN cases have less apoptosis,while non PMN cases have much more apoptosis,which scatters mainly adjacent to the septa.This might be related to the mechanism of cirrhosis in hepatitis B;PMN would disappear in late stage of cirrhosis;CLBD proliferation and fibrosis are the important changes of PMN in cirrhosis stage. Hepatitis B virus Cirrhosis \