1883份肝穿刺活检组织标本病理分析

Clinical and pathological analysis for 1883 cases of liver biopsy

目的分析肝穿活检组织病理检查结果,加深对各种肝病的认识。方法 B型超声引导下采用快速穿刺法取肝组织,对肝穿组织进行HE染色、网状纤维染色及胶原纤维染色,用免疫组织化学法检测肝组织中HBsAg、HBcAg、HCV,根据需要加做其他免疫组织化学及特殊染色,如刚果红、PAS、铜、铁等。结果所有病理诊断中,肝炎1234例,占65.53%,其中乙型肝炎856例,占45.46%。有573例临床诊断为不明原因的肝损伤,病理诊断203例为肝炎,占35.43%,其中乙型肝炎8例,占1.40%,乙型肝炎临床诊断与病理诊断的符合率为95.50%。自身免疫性肝病177例,占30.89%。Dubin-Johnson综合征6例,占0.32%,HE染色中央静脉周围肝细胞见较多粗大深棕色色素颗粒;肝淀粉样变5例,占0.27%,淀粉样蛋白主要沉积于肝窦周围隙,刚果红染色呈桔红色;血色病5例,占0.27%,含铁血黄素在肝小叶弥漫分布,普鲁士蓝染色呈蓝色。肝糖原贮积症有2例,占0.11%,细胞质内有大量糖原沉积,PAS染色呈红色。结论临床资料对病理诊断意义重大,肝穿刺活检对各种肝病诊断具有重要的价值。

Objective To deepen the understanding of various liver diseases through the analysis of the pathological results from liver biopsy. Methods By B ultrasonic guided rapid needle biopsy,liver tissues from 1883 patients with liver diseases were collected for HE staining,reticular fiber staining and collagen fiber staining,respectively. Then HBsAg, HBcAg and HCV in liver cells were assessed by immunohistochemical assay. Other immunohistochemical methods and specific staining,such as Congo red,PAS,copper and iron,would be adopted if necessary. Results Among all pathological diagnoses,there were 1234 cases （65.53% ）of hepatitis,of which 856 cases （45.46% ）were hepatitis B virus infection. Among 573 cases that were clinically identified as unexplained liver injury,203 cases （35.43% ）were hepatitis by pathological diagnosis,of which 8 cases （1 .40% ）were MS-2 hepatitis and 177 cases （30.89% ）were autoimmune liver disease. The coincidence rate of clinical and pathological diagnosis for MS-2 hepatitis was 95.50% . Besides,2 cases （0.11% ）of Von gierke disease were confirmed by pathological results,for which there were a large number of glycogen deposits in hepatic glycogen cytoplasm and nucleus,and PAS staining showed red;5 cases were liver amyloidosis （0.27% ）, with deposits of amyloid protein mainly on perisinusoidal space and stained orange with Congo red;6 cases were Dubin-Johnson syndrome （0.32% ）,with many bulky dark brown granules in cells surrounding central venous and capillary bile duct after HE staining;5 cases （0.27% ）were hemochromatosis,with hemosiderin diffusely distributed in hepatic lobule and a Prussian blue reaction presented. Conclusion The clinical materials are of great significance for pathological diagnosis,and the pathological results based on liver biopsy have an important value for the diagnoses of various liver diseases.