91例慢性乙型重型肝炎肝衰竭患者的临床病理分析  

A retrospective study of clinical and pathological spectrum in 91 patients with chronic severe hepatitis B

作　　者：刘旭华[1] 郑素军[1] 祖可佳[1] 陈煜[1] 陈义森[1] 王泰龄[2] 段钟平[1] 

机构地区：[1]首都医科大学附属北京佑安医院人上肝治疗中心,北京100069 [2]中日友好医院病理科

出　　处：《中华肝脏病杂志》2010年第10期721-725,共5页Chinese Journal of Hepatology

基　　金：基金项目：＂艾滋病和病毒性肝炎等重大传染病防治＂科技重大专项（十一五计划）资助项目（2008ZX10002-005-3）;首都医学发展科研基金资助项目（2005-102）;国家重点基础研究计划（973计划）资助项目（2007CB512801）;北京市科技新星项目（2007B055）

摘　　要：目的 观察慢性乙型重型肝炎（CSHB）肝衰竭的临床和病理形态特点.方法 回顾性分析91例CSHB临床和病理资料,按其发病前基础病情分为慢性HBV携带组（HBC）、慢性乙型肝炎组（CHB）和肝硬化组（LC）,分析各组患者出现肝衰竭的类型、临床特点和病理特点.结果 91例CSHB患者中,男性74例,女性17例,平均年龄（40.6±11.2）岁,发生在HBC者9例（9.9%）、CHB者7例（7.7%）、LC者75例（82.4%）.平均年龄在HBC组为（25.8±6.6）岁、CHB组为（36.9±9.0）岁、LC组为（42.0±10.5）,HBC组平均年龄较CHB组和LC组小,P值分别为0.032和0.001.各组患者肝衰竭类型均以哑急性为主,发生肝衰竭时间为15～150d,平均（42.2±30.6）d,以黄疸深、腹水为突出特点.常见诱因为劳累、重叠感染、病毒变异、应用肝损伤药物及饮酒.各组CSHB患者的凝血酶原时间、活动度和总胆红素差异无统计学意义.白蛋白、胆碱酯酶在LC组分别为（30.3±5.1）g/L和（2926.8±1471.1）U/L、HBC组分别为（35.6±5.1）g/L和（4363.5±2063.2）U/L、CHB组分别为（37.4±5.0）g/L和（5167.1±1522.1）U/L,LC组白蛋白、胆碱酯酶均明显低于HBC组和CHB组,F值分别为9.450和9.297,P值均＜0.01.胆固醇LC组为（1.8±1.0）mmol/L、HBC组为（2.9±1.0）mmol/L,LC组低于HBC组,P=0.034,差异有统计学意义.HBV DNA定量HBC组为（6.8±1.7）log10拷贝/ml、LC组为（4.2±2.6）log10拷贝/ml,HBC组高于LC组,P=0.019,差异有统计学意义.HBC和CHB基础上的CSHB肝脏病理表现主要为大块或亚大块坏死,病变较均匀,与急性/亚急性重型肝炎的病理特点并无显著区别,CHB基础上的CSHB,出现广泛坏死时极易掩盖原有病变,Masson染色可显示汇管区周围纤维化.肝硬化基础上者病变不均一,大块或亚大块坏死的同时总有部分结节保留,不同部位坏死范围及新旧程度不一.结论 我国CSHB多发生于肝硬化基础上,其病理特征与慢加急/亚急性肝�Objective In China, liver failure is also termed as severe hepatitis in whom chronic severe hepatitis B （CSHB） is most common. The aim of this study was to assess whether CSHB based on different liver injury extent can meet the international definition of acute-on-chronic liver failure（ACLF） criteria, according by their clinical and pathological feature. Methods A total of 91 patients with CSHB were involved in the study. The clinical findings, laboratory data and liver pathology features were retrospectively analyzed and grouped by hepatitis virus B carrier state （HBC）, chronic hepatitis B （CHB） or liver cirrhosis （LC） before they started liver failure. Results 74 out of the 91 patients were male and 17 were female, the mean age was 40.6 ± 11.2 years. 9.9%, 7.7% and 82.4% of the patients were based on HBC, CHB and LC respectively. The ages of HBC group were youngest. The mean age of HBC group （years） （25.8 ± 6.6） was significantly lower than that of CHB group （36.9 ± 9.0） and LC group （42.0 ± 10.5）with P values of 0.032 and 0.001 respectively. Most cases presented with sub-acute liver failure characterized by high icterus and ascites. Predisposing factors included exertion, superinfection, virus variation, drugs or alcholic injury. No difference found between PTA （F = 0.906, P= 0.408） and TBil （F= 0.839, P = 0.436） among the above three groups. The Alb and CHE levels in LC group were （30.3 ± 5.1） g/L and （2926.8 ± 1471.1） U/L respectively,which were lower than both HBC group [Alb （35.6 ± 5.1） g/L, CHE （4363.5 ± 2063.2） U/L] and CHB group [Alb （37.4 ± 5.0） g/L, CHE （5167.1 ± 1522.1） U/L] （F = 9.450; F = 9.297; P 〈 0.01）.The level of CHO （1.8 ± 1.0） mmol/L in LC group was lower than that of HBC group （2.9 ± 1.0mmol/L, P = 0.034）,while serum HBV DNA level of HBC group [（6.8 ± 1.7） log10copies/ml] was higher than that of LC group [（4.2 ± 2.6） log10copies/ml]. The liver tissue in HBC and CHB group showed massive or

关 键 词：肝炎 乙型 慢性 肝功能衰竭 病理学 荟萃分析 

分 类 号：R686[医药卫生—骨科学]