从组织病理学角度探讨慢性乙型肝炎肝纤维化的发生  

Pathogenesis of liver fibrosis in patients with chronic hepatitis B

作　　者：石军[1] 郝菁华[1] 任万华[1] 朱菊人[1] 王书运[2] 谢英渤[2] 

机构地区：[1]山东大学附属省立医院肝病中心,济南250021 [2]山东师范大学电镜室

出　　处：《中华肝脏病杂志》2009年第6期443-445,共3页Chinese Journal of Hepatology

摘　　要：目的探讨窦内皮细胞在肝纤维化发生中的作用，以及肝脏微循环障碍、肝窦毛细血管化与肝纤维化发生的关系。方法对56例慢性乙型肝炎患者进行肝活组织检查，将肝组织分成两部分，分别通过HE染色进行光学显微镜观察，以及常规制作电子显微镜标本在透射电子显微镜下进行超微结构观察。结果56例慢性乙型肝炎患者中，轻度39例，中度10例，重度7例。慢性乙型肝炎患者肝星状细胞的形态类似成纤维细胞，周围有胶原纤维形成。窦内皮细胞与肝星状细胞间有电子致密物沉积。其中53例窦内皮细胞窗孔有不同程度的减少、减小，20例见窦内皮细胞下有连续或不连续的膜样物质形成，15例狄氏腔内有胶原纤维沉积。15例肝功能正常患者有的肝窦腔内有红细胞聚集，严重者有微血栓形成。结论窦内皮细胞通过与肝星状细胞作用，从而参与肝纤维化的发生。肝脏微循环障碍、肝窦毛细血管化是肝纤维化的早期重要病理改变。Objective To explore the role of sinusoidal endothelial cell in the development of liver fibrosis, and to dissect the relationship among hepatic microcirculation disorders, hepatic sinusoidal capilarization and liver fibrosis. Methods Liver biopsy was performed in fifty-six patients with chronic hepatitis B. The liver tissues were observed under light microscope and transmitted electronic microscope. Results Of 56 cases, 39 cases were mild hepatitis, 10 were moderate hepatitis, and 7 were severe hepatitis. The morphology of hepatic stellate cells （HSCs） was similar to that of fibroblasts in the tissues of the patients with chronic hepatitis B. Collagenous fibers were deposited around the hepatic stellate cells. Electron-dense materials were deposited between sinusoidal endothelial cell and hepatic stellate cell. The size and amount of fenestraes of sinusoidal endothelial cells were reduced in 53 of 56 cases. The consecutive or inconsecutive membrane-like materials were observed along sinusoidal endothelial cells in 20 cases. Collagen fibers were observed in the space of Disse in 15 cases. Even in the patients with normal hepatic functions, red blood cells aggregation and microthrombi could be observed in the liver tissues. Conclusion Sinusoidal endothelial cells are involved in development of liver fibrosis by interacting with hepatic stellate cells. Hepatic microcirculation disorders and sinusoidal capillarization are important changes in the early stage of liver fibrosis.

关 键 词：肝炎 乙型 慢性 肝纤维化 肝星状细胞 窦内皮细胞 

分 类 号：R512.62[医药卫生—内科学] R739.5[医药卫生—临床医学]