慢乙肝患者肝微循环的超微结构病变及其与肝功能障碍的关系

CORRELATION BETWEEN HEPATIC MICROCIR CULATION ULTRASTRUCTURAL CHANGES AND HEPATIC DYSFUNCTION IN CHRONIC HEPATITIS

作者对41例病理确诊为慢性乙型肝炎患者的肝微循环超微结构病变及肝功能进行了观察,发现不同型的慢性乙型肝炎患者均有不同程度的肝微循环病变,而且无论其病变程度如何,均有SGPT、ZnT或TT的不同程度升高。由此表明,一旦出现肝功能轻度损害就意味着有肝微循环障碍;A/G比值与γ-球蛋白升高的频率在肝微循环重度损害的病例中更高,这对于判断病情轻重有一定意义。作者强调,在慢乙肝的治疗中应重视早期改善肝脏的微循环。

The author observed the ultrastructuralchanges of hepatic microcireulation and thefunction of the liver in 41 cases with chron-ic hepatitis B confirmed histologically.The main ultrastructural changes found inpatients were swelling of the endotheliumof hepatic sinusoids, hyperplasia of Kupffercells and decrease of fenestrae in the endo-thelium. Proliferation of monocytes andfat-storing cells was also found in the lumi-na of hepatic sinusoids and space of hepato-cytes and perisinusoid. The basementmembrane in hepatic sinusoids and thebase of hepatocytes were formed in thepatients with marked pathologic changes ofthe liver, especially in CAH with cirrhosis. The observations also showed thatwhatever extent of hepatic microcireulationchanges, all of them had more or less ele-vation of SGPT and ZnT or TT. As soonas hepatic function was impaired slightly,there occurred hepatic dysmicrocirculation.But in the cases of severe ultrastructuralhepatic dysmicrocirculation serum gammaglobulin elevation values and A/G ratioexchanges were much higher than those inthe cases of slight changes. There was somesignificance on the judgment of sickcondition, slight or severe. Values of theelevation of serum gamma globulin and A/Gratio exchanges were much more obviousthan SGPT, ZnT and TT changes. Thesefindings suggest that the extents of patho-logical changes and dysfunction of the liverin chronic viral hepatitis B are correlatedto the extent of hepatic microcirculationimpairment. So in the treatment of chronichepatitis early administration of medicine toimprove the liver microcirculation should beconsidered.