散发性戊型肝炎肝组织病理学及病毒学研究  

Pathological and virological studies of the liver tissues from the patients with sporadic hepatitis E

作　　者：赵景民[1] 王松山[1] 张泰和[1] 刘平[1] 周光德[1] 孙燕铃 尹铁勇[1] 

机构地区：[1]解放军第302医院病理科,北京100039

出　　处：《中华实验和临床病毒学杂志》2001年第3期205-207,共3页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的　研究散发性戊型肝炎 (HE)肝组织病理特征、病毒分布及复制 ,探讨戊型肝炎病毒 (HEV)致肝损伤机制。方法　对 36例发病急性期 (2 0例 )和恢复期 (16例 )穿刺肝组织 ,及 18例慢性乙型肝炎 (CHB)近期重叠HEV感染肝组织 ,作光、电镜组织学观察 ,原位杂交HEVRNA检测 ,Kupffer细胞免疫组化观察。结果　HE急性期肝组织病变有其相对特征 :易见肝细胞羽毛状变性(10 0 0 % )、毛细胆管内淤胆 (75 0 % )及双核、多核肝细胞 (65 0 % ) ,肝细胞凋亡小体偏大且不整 ,Kupffer细胞增生突出等。HEVRNA分布于肝细胞胞质近核周处 ,急性期肝组织HEVRNA阳性率(10 0 0 % )明显高于恢复期 (12 5 % ,P <0 0 0 1) ,且阳性肝细胞及病毒拷贝数较多 ,恢复期肝组织趋于复常。CHB重叠HEV感染者肝组织炎症活动度较单纯CHB为重。结论　散发性HE相对于其他病毒性肝炎有其病理学特征 ;HEV感染肝细胞并主要于发病急性期复制活跃 ;急性散发性HE恢复后转归良好 ;细胞免疫性肝损伤可能为HEV的主要致肝损伤机制 ,但不能排除存在病毒直接致肝损伤作用。Objective To study the pathological feature,viral distribution and replication in the liver tissue of sporadic hepatitis E(HE),and to explore the mechanism of the liver injury induced by hepatitis E virus(HEV).Methods The total bioptic liver tissues( n=54 )were obtained from the patients with sporadic hepatitis E,including the clinical acute stage( n=20 ),the convalescent stage( n=16 ),and the chronic hepatitis B(CHB)overlapped with HEV infection recently( n=18 ).The pathological changes in the liver tissues were observed under the light and the electron microscope.HEV RNA was detected by in situ hybridization,and Kupffer cells were marked with immunohistochemistry.Results The HE liver tissues showed the pathological features in the clinical acute stage,presenting frequently with feathery degeneration of hepatocytes(100%),cholangiolar cholestasis(75 0%),and double nuclei and multinuclei hepatocytes(65.0%).The apoptotic body of hepatocyte was larger and irregular,and the proliferation of Kupffer cells was prominent.HEV RNA was distributed in hepatocyte cytoplasm near the nuclei.The positive rate of HEV RNA in acute stage was evidently higher than that in convalescent stage(100% vs 12.5%, P <0.001),and the HEV RNA positive hepatocytes and the viral copies in acute stage were also more than in convalescent stage,in which the liver tissues were becoming normal.The liver tissue changes of the CBH overlapped with HEV infection were more severe compared with the single CHB.Conclusion Sporadic HE had histopathological characteristics.HEV infection and replication in hepatocytes occurred mainly during clinical acute stage and regressed in convalescent stage,which suggested sporadic acute HE may have a good result.The immune mediated liver injury by lymphocytes might be a main pathogenesis of HE,but the liver injury induced directly by HEV might not be excluded.

关 键 词：戊型肝炎病毒 散发性戊型肝炎 病理学 肝组织 病毒学 

分 类 号：R512.6[医药卫生—内科学]