肝移植术后乙型肝炎复发患者的临床病理特征  

Clinical pathology of recurrent hepatitis B after liver transplantation

作　　者：焦作义[1] 张冬红[1] 严律南[2] 

机构地区：[1]兰州大学第二医院普外一科、甘肃省消化系肿瘤重点实验室,730030 [2]四川大学华西医院肝移植中心

出　　处：《中华肝脏病杂志》2014年第9期654-659,共6页Chinese Journal of Hepatology

基　　金：中国高校基本科研业务费专项基金（L-2013-m04）;陇原青年创新人才扶持计划（200861号）

摘　　要：目的 初步了解肝移植术后乙型肝炎复发患者的临床病理特征.方法 收集12例乙型肝炎复发患者肝移植术后各期临床表现,采用苏木素-伊红染色,HBsAg和HBcAg免疫组织化学染色,HBV DNA原位杂交以及Mallory三色染色方法对各期肝穿刺组织进行检测,总结乙型肝炎复发各期的临床病理特征.数量资料采用相对数表示,乙型肝炎复发后患者生存率采用Kaplan-Meier法计算.结果 乙型肝炎复发后早期临床表现为：HBV复制活跃,肝功能轻到中度异常,病理学表现为轻到中度病毒性肝炎.4例在乙型肝炎复发后缺少有效抗病毒治疗的患者最终进展为淤胆硬化性肝炎,临床表现为：HBV复制活跃,进行性黄疸和肝功能恶化,其病理学表现为：肝细胞结节状再生,肝内胆汁淤积,汇管区广泛纤维化、炎细胞浸润及胆管组织增生.结论 早期及时获得有效抗病毒治疗的乙型肝炎复发患者临床病理表现为轻度肝炎,少数患者可进展为淤胆性肝硬化,值得进一步研究.Objective To investigate the clinical pathology of recurrent hepatitis B after orthotopic liver transplantation （OLT）.Methods The clinical manifestation and hepatic pathological characteristics of 12 patients with recurrent hepatitis B after OLT were examined in this study by using hematoxylin and eosin staining,immunochemical staining of hepatitis B surface antigen and hepatitis B core antigen,tissue in situ hybridization of hepatitis B virus （HBV） DNA,and Mallory＆#39;s trichrome staining.The survival rate of these OLT patients was assessed by Kaplan-Meier analysis.Results The early stage of recurrent HBV infection in patients with OLT was characterized by active HBV replication and mild-to-moderate inflammation in the liver.Three of the 12 patients who were treated with combination therapy group were carriers of YMDD mutants and all three showed improvement in liver function and hepatic histology after receiving adefovir dipivoxil,instead of lamivudine,in the early stage of recurrent hepatitis B after OLT.Among the patients treated with lamivudine monotherapy,four did not achieve improvement at the early stage of recurrent hepatitis B and developed fibrosing cholestatic hepatitis （FCH）.Conclusion Recurrent hepatitis B in patients who underwent OLT was characterized by mild-to-moderate viral hepatitis at the early stage and FCH at the later stage.Effective antiviral intervention at the early stage may reverse recurrent hepatitis B and prevent the disease progression to fatal FCH.

关 键 词：肝移植 肝炎 乙型 复发 病理学 

分 类 号：R657.3[医药卫生—外科学]