结合病理学改变探讨重型肝炎的分类及时限划分

Classification of severe hepatitis based on histopathological study

目的 :从病理角度探讨我国现行的急性、亚急性重型肝炎的时限划分是否能与国际接轨 ,以及急性重型肝炎是否存在病理亚型。方法 :对比国内外有关资料 ,对北京地坛医院 4 8例急性和 79例亚急性重型肝炎的肝穿刺病理切片作重点观察。结果 :从时间上看 ,我国的急性重症肝炎 (<10d)与亚急性重症肝炎的急性期 (10d～ 30d)分别相当于国外急性肝衰竭中的超急性及暴发性亚型 ;如将我国亚急性重症肝炎中的急性期归入急性重症肝炎 ,则不论时限划分还是病理变化均与国际一致。急性重型肝炎的主要病变为肝细胞的急性广泛坏死(大块、亚大块或桥接坏死 ) ,坏死 >2 / 3者 ,多不能存活 ;如坏死≤ 1/ 2 ,存活肝细胞虽有变性 ,经及时治疗 ,再生迅速 ,多数可望修复 ,年轻者预后尤佳。结论 :我国重型肝炎的病变规律与国际上一致 ,不难接轨 ;急性重型肝炎不存在水肿亚型 ,其坏死范围的大小直接影响预后。

Objective:To assess whether the Chinese classification of acute severe hepatitis(ASH)and subacute severe hepatitis(SASH) can meet the international criteria based on pathologic features and are there pathological subtypes in ASH?Methods:Pathology of the biopsies of 48 ASH and 79 SASH with follow up liver biopsies were restudied.Results:The pathology of early stage of SASH(10 30 d)in China is equivalent to that of acute hepatic failure(AHF)in abroad(<4 week).If the cut off is 4 week,the clinical feature between acute and subacute,as well as the pathological changes will be clearly classified.The main lesion in the liver of ASH is an one attack of massive or submassive hepatic necrosis.If the necrotic area is >2/3,the prognosis is poor,while <1/2 most of the patients may have a change to recover,especially younger ones.Conclusion:The basic pathology of the so called acute stage of SASH is identical to that of ASH.Practically there is no need to categorize SASH to 3 stages.So it is possible to make the classification meet with the international creteria.The hepatic necrotic area is a reliable prognostic marker for severe hepatitis.Edematous subtype actually does not exist.