肝移植术后纤维化胆汁淤滞性肝炎  

The unique pattern of fibrosing cholestatic hepatitis after liver transplantation

作　　者：陈嘉薇[1] 陈大志[1] 陈昭民[1] 付红[1] 

机构地区：[1]哈尔滨医科大学第二临床医学院病理科,150086

出　　处：《中华器官移植杂志》2000年第2期75-76,共2页Chinese Journal of Organ Transplantation

摘　　要：目的　探讨肝移植术后乙型肝炎复发的病理学特征和鉴别诊断。方法　对 1例乙型肝炎后肝硬化患者在肝移植术后进行定期肝穿刺组织学检查。结果　肝移植术后 2 5d血中HBsAg、HBeAg和HBV DNA均转为阴性。然而 ,术后 5 8dHBsAg再次阳性。同时肝穿刺组织学检查见肝细胞气球样变并互相融合形成片状坏死 ,汇管区和门静脉周围出现纤维化 ,部分肝细胞和肝小管内可见胆汁淤滞 ,肝细胞呈HBsAg和HBcAg免疫反应阳性。临床特点为胆红素进行性升高 ,凝血酶原时间逐渐延长 ,肝脏酶学检查均升高 ,持续一段时间后迅速下降 ,顽固性低蛋白血症 ,同时伴随一般状态的迅速恶化。结论　纤维化胆汁淤滞性肝炎是肝移植术后HBV再感染的一种特殊形式 ,其临床经过凶险 ,病理学改变具有特异性 ,与通常的乙型肝炎有显著的不同。Objective To explore the pathological features and the differential diagnosis of recurrent HBV after liver transplantation.Methods One case of liver transplantation for HBV cirrhosis was subjected to liver biopsies on time postoperatively.Results 25 days after liver transplantation, the HBsAg, HBeAg and HBV DNA of the patient were negative, but the HBsAg was positive again on the day of 58 after liver transplantation. The histopathological examination showed the balloon like change of hepatocytes with the fragmental necrosis, fibrosis in portal areas and around the portal veins, cholestasis in some of hepatocytes and canaliculus, and a positive of HBsAg and HBcAg with immunohistochemical stain. The clinical features were: progressive increase of hepatic enzymes levels which maintained for some time and then decreased rapidly, stubborn hypoproteinemia in company with the aggregation of general situation of the patients.Conclusions fibrosing cholestatic hepatitis (FCH) is a special type in recurrent infection of HBV after liver transplantation. It had a serious clinical process and specific pathological changes which differentiated from the usual HBV.

关 键 词：肝移植 纤维化胆汁淤滞 肝炎 病理学 术后 

分 类 号：R657.3[医药卫生—外科学] R575.1[医药卫生—临床医学]