肝活检对先天性胆道闭锁与婴儿肝炎综合征鉴别及预后判断的意义  

Significance of Liver Biopsy in the Differential Diagnosis and Prognosis of Congenital Biliary Atresia and Infant Hepatitis Syndrome

作　　者：杜瑞[1] 陈文静[1] 郭玉娟[1] 郜红艺[1] DU Rui;CHEN Wen-jing;GUO Yu-juan;GAO Hong-yi(Department of pathology, Guangdong Women and Children Hospital, Guangzhou, 511440)

机构地区：[1]广东省妇幼保健院病理科,广东广州511400

出　　处：《中山大学学报（医学版）》2018年第3期438-442,482,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A008096)

摘　　要：【目的】探讨肝活检病理检查对先天性胆道闭锁(CBA)和婴儿肝炎综合症(IHS)鉴别诊断及预后判断的重要意义。【方法】对2012年12月到2016年12月在广东省妇幼保健院就诊的77例先天性胆道闭锁和48例婴儿肝炎综合症的患儿进行肝活检病理检查和随访,并结合免疫组化及PAS染色、网状纤维染色和Masson染色技术,对比分析两者的组织病理学特征及预后。【结果】CBA与IHS患儿的肝纤维化分级、肝小叶炎症活动度分期、胆小管增生程度及预后的差异均具有统计学意义(P<0.05)。CBA患儿的肝纤维化分级以S2~S3为主,肝小叶炎症活动度分期以G2~G3为主,胆小管增生显著;IHS患儿的肝纤维化分级以S0~S1为主,肝小叶炎症活动度分期以G1~G2为主。CBA患儿的预后明显差于IHS,且差异具有统计学意义(P<0.05)。【结论】早期对先天性胆道闭锁和婴儿肝炎综合征的患儿进行肝活检病理检查,并结合免疫组化和PAS染色、网状纤维染色和Masson染色技术进行分析,对于两者的鉴别诊断及预后判断具有重要的临床意义。【Objective】 To investigate the significance of liver biopsy in differential diagnosis and prognosis ofcongenital biliary atresia（CBA）and infant hepatitis syndrome（IHS）.【Methods】Totally 77 children with congenitalbiliary atresia and 48 infants with hepatitis syndrome treated in Guangdong Women and Children Hospital from December 2012 to December 2016 were examined by liver biopsy and follow-up. Combined with immunohistochemistry and PASstaining,reticular fiber staining,Masson staining techniques,we make comparative analysis of both histopathological fea-tures and prognosis.【Results】The liver fibrosis grade,hepatic lobule inflammation activity staging,the degree of bileduct hyperplasia and the prognosis of CBA and IHS infants were statistically significant（P〈0.05）. S2-S3-based liver fi-brosis grading in infants with CBA,mainly in G2-G3 hepatic lobule inflammation staging,bile duct hyperplasia signifi-cantly;IHS infants with liver fibrosis grading as S0-S1,liver Slice inflammatory activity stage to G1-G2-based. The prog-nosis of infants with CBA was significantly worse than IHS,and the difference was statistically significant（P〈0.05）.【Conclusion】The early liver biopsy of infants with congenital biliary atresia and infant hepatitis syndrome,combined withimmunohistochemistry and PAS staining,reticular fiber staining,Masson staining techniques has important clinical signif-icance to the differential diagnosis and prognosis of both.

关 键 词：肝活检 胆道闭锁 婴儿肝炎综合症 鉴别诊断 预后 

分 类 号：R365[医药卫生—病理学]