肝癌患者肝内HBsAg表型及分布(211例手术切除肝癌免疫组织化学研究)

Phenotype and Distribution of Intrahepatic HBsAg in Patients with Hepatocellular Carcinoma (HCC):Analysis of 211 Resected HCC Specimens by Immunohistochemical Staining

本文对肝癌高发区211例手术切除肝细胞癌标本,应用免疫组织化学(PAP法)对肝内HBsAg表型及分布进行研究,结果如下:1.非癌肝组织154例(73%)HBsAg阳性,其表型可分为胞浆型(55.8%),胞膜型(10.4%)及胞浆-膜混合型(33.8%)三型。胞浆型多散在分布,而膜型及混合型多聚集成片。2.肝内HBsAg检出率受肝内多种病变(特别是肝硬化及肝炎)所影响,在肝细胞损伤及病变活动时肝内HBsAg多呈膜型或混合型,而病变静止时则多呈胞浆型。3.肝内HBsAg检出率与肝癌患者年龄有密切关系,青年组阳性率高达87.5%,而老年组则仅41%。本文讨论中指出,在我国肝癌高发区,肝硬化并不是肝癌发生不可缺少的前驱病变,部分病例在由HBV所引起的慢性肝炎基础上直接发生为癌,HBV可能是肝硬化及肝癌共同致病因素,在其它致癌物(黄曲霉毒素)共同作用下,加速肝癌形成。

To understand the phenotype and the distribution of intrahepatic HBsAg in the pa-tients with HCC,specimens from 211 resectable cases of HCC were investigated and ana-lysed,by using immunohistochemical staining (PAP method).The results were as follows: 1. The positive rate of HBsAg in cases of non-cancerous liver tissue was 73%(154 ca-ses).The phenotype patterns of HBsAg in hepatocytes could be divided into three types:cytoplasmic type (55.8%),membranous type(10.4%) and cytoplasmo-membranous (mixed)type (33.8%).The hepatocytes of the cytoplasmic type were mostly scattered,while thehepatocytes of membranous and mixed types were usually assembled. 2. The positive rate of HBsAg was chiefly dependent upon liver cirrhosis and the typeof hepatitis and it varied with some other hepatic lesions.The mambranous and mixedtypes were closely related to the hepatocellular demage and the activity of hepatic lasions. 3. The rate of positivity of HBsAg was closely correlated with the age of the patientssuffer ing from HCC.It was higher in the younger patients (87.5%) than that in theold-aged group (41.7%). The relationship between HBV and HCC was briefly discussad.It suggested thatHCC might not be necessarily associated with hepatic cirrhosis.And HCC could be di-rectly induced by HBV through chronic hepatitis.