肝移植受体病肝组织中丙型肝炎病毒的检出及其临床意义

Detection of hepatitis C virus in liver transplantation recipients

目的:检测成人肝移植受体丙型肝炎病毒(HCV)感染状态,探讨监测肝移植受体术后丙型肝炎复发的意义。方法:收集本移植中心器官移植受体摘除肝脏标本52例,采用Tordji鄄22和NS32种单克隆抗体进行免疫组织化学检测。结果:所有病例术前血清抗HCV检测均阴性。52例肝移植受体肝脏组织中20例(38.46%)肝细胞内有不同程度的HCV抗原存在。上述2种单克隆抗体的灵敏度及阳性表达方式略有不同,Tordji鄄22以肝细胞核表达为主,NS3以肝细胞胞质细颗粒状阳性为主。原发性肝癌肝移植组中HCV阳性细胞主要为癌旁肝细胞,少数癌细胞胞质也呈弱阳性。结论:在接受肝移植的慢性终末期肝病或原发性肝癌患者中,有相当病例受体肝脏有HCV感染。由于肝移植后应用大剂量皮质激素及免疫抑制药物可促进HCV病毒在移植肝的肝细胞内复制,导致丙型肝炎复发,明确肝移植受体肝脏HCV感染状态,对肝移植后病情监测、制定治疗方案具有指导意义。

Objective To explore the HCV infection and its clini ca l significance in adult liver transplantation re-cipients.Methods Liver specime ns obtained from52liver transplantation recipients were collected and analyzed w ith Tordji-22and NS3anti-HCV monoclonal antibodies immunohistochemically.Of th e52recipients,27were patients with hepatocytic cancer(HCC group),and other25were benign endstage liver disease.Results The serum anti-HCV of the patients were all negative before transplantation.Twenty specimens(38.46%)of the liver tissure in the recipients were positive HCV antigen.The sensitivity and positive expres sion pattern of the Tordji-22antibody showed nuclear expression pattern,whereas NS3antibody showed cytoplasm expression pattern.In HCC group,positive cells wer e predominantly per-i-cancerous hepatocytes.Only small amount of cancer cells showed HCV positive.Conclusions Since the lower HCV level and lower replicative rate in hepatocytes,pre-operatively accurate detection for HCV infection in per ipheral blood is difficult.However,over one third of liver transplantation recip ients show HCV infection in their liver specimen.The post-operative management of steroid and immunosuppressive drugs could induce the HCV replication and recu rrence of hepa-titis C and accelerate progression of the cirrhosis,therefore,co nfirming the status of HCV infection in the recipients is very important in surv eillance of hepatitis C recurrence and in design of proper treatment.