血吸虫病患者肝纤维化的病理变化与超微结构观察

Pathological microstructure and ultrastructure changes of liver fibrosis in patients with schistosomiasis liver fibrosis

目的探讨血吸虫病肝纤维化显微结构与超微结构的病理改变。方法在浙江省衢州市人民医院内科，选择2003年1月至2009年1月收治的9例血吸虫病肝纤维化患者的肝活检病理石蜡标本．进行光镜显微结构观察，然后将石蜡块改制树脂包埋块，制成超微切片，采用电子显微镜（电镜下）进行超微结构观察。结果9例血吸虫病肝纤维化标本，光镜下，可见纤维疤痕形成及纤维钙化的虫卵结节；电镜下，可见肝细胞轮廓清楚，肝细胞核周隙扩张、粗面内质网数量减少，线粒体嵴肿胀，肝窦及周围有胶原纤维沉积．小静脉周围的胶原纤维束向肝小叶周围延伸，不易找到虫卵。结论电子显微镜能观察血吸虫病肝纤维化细胞的精细结构，但不易找到虫卵；光学显微镜易于发现纤维钙化的虫卵结节，两者可以相互补充观察内容。

Objective To explore the pathological changes of liver fibrosis of patients with schistosomiasis liver fibrosis. Methods Between January 2003 and January 2009, microstructure retrospective observation of liver biopsy pathological paraffin specimens by optical microscope was carried out in 9 cases of patients with schistosomiasis liver fibrosis in Quzhou people＇s hospital internal medicine. Then those paraffin blocks were changed to resin embedding blocks and superfine slices were made. Ultrastructure observation by electronic microscope was carried out. Results Visible fibrous scar formation and fiber calcified nodule eggs in microscopic structure of liver tissue in 9 cases of patients with schistosomiasis liver fibrosis were observed. Ultrastructural observation of the 9 cases of patients with schistosomiasis liver fibrosis showed that most of the liver cell profile was clear, liver cell nucleus gap expanded, the number of rough endoplasmic reticulum decreased, swollen mitochondfia crest occurred, collagen deposited around hepatic sinus and surroundings and collagen fiber bundle around small veins extended to hepatic lobule and surroundings, and calcified nodule eggs were not easy to find. Conclusions Under an electron microscope,＇diseased tissue cells can be observed at subcellular level or organelle level, which provides more insight into the pathology of schistosomiasis liver fibrosis. Calcified egg nodules are easily found by an optical microscope other than an electron microscopy. The two can complement each other.