乙型肝炎相关慢加急性肝衰竭合并脓毒症的病理特征  

Pathological characteristics of hepatitis B virus related acute-on chronic liver failure complicated with sepsis

作　　者：杨淑殷[1] 李淑婷[1] 薛峰[2] 王蓓蓓[3,4] 曾菠[1] 张楠楠[1] 陈柳莹[1] 王泰龄[5] 李海[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化科,上海市消化疾病研究所,上海200001 [2]上海交通大学医学院附属仁济医院肝移植科,上海200127 [3]首都医科大学附属北京地坛医院传染病研究所,北京100015 [4]新发突发传染病研究北京市重点实验室,北京100015 [5]北京中日友好医院病理科,上海200001

出　　处：《中国肝脏病杂志（电子版）》2014年第2期6-9,共4页Chinese Journal of Liver Diseases：Electronic Version

基　　金：国家自然基金项目(30770962;30971333;81170421)

摘　　要：目的观察乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)合并脓毒症肝脏病理改变。方法选择50例HBV-ACLF肝移植患者的移植前肝脏标本,制成石蜡切片,经HE染色、Masson三色染色和抗细胞角蛋白-7(CK-7)免疫组织化学染色,镜下观察肝脏病理变化。结果 HBV-ACLF合并脓毒症的病理改变为在肝硬化基础上发生大块/亚大块坏死,部分肝硬化结节残留,结节边缘细胆管扩张,腔内有浓缩胆汁,细胆管上皮细胞萎缩甚至消失。结论 HBV-ACLF合并脓毒症时肝脏表现为残留结节边缘细胆管胆汁淤积,但需要注意与其他类型的胆汁淤积鉴别。Objective To observe pathological changes in hepatitis B virus related acute-on chronic liver failure （HBV-ACLF） complicated with sepsis. Methods Liver specimens were selected from 50 cases of HBV-ACLF, made into paraffin slices, stained with HE staining, masson trichrome staining and CK-7 immunohistochemical staining and examined under a microscope. Results The characteristics of HBV-ACLF with sepsis were as followed：Massive/submassive necrosis was generated on cirrhosis with some residual nodules. There was different degree of ductular dilatation, cholestasis and epithelial cells atrophy in ductules on the margins of the residual nodules. Conclusions The characteristic of HBV-ACLF with sepsis was ductular cholestasis, which should be distinguished from other types of cholestasis.

关 键 词：乙型肝炎 慢加急性肝衰竭 脓毒症 胆汁淤积 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]