慢性乙型肝炎免疫耐受期患者肝穿组织的临床病理学特征

摘要

目的:总结慢性乙型肝炎免疫耐受期患者的临床病理学特征.方法:收集符合慢性乙型肝炎免疫耐受期临床诊断并行肝组织穿刺活检的病例共84例,血清学检测其乙肝病毒(HBV)标志物、HBV DNA病毒载量及丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平.所有标本均行HE染色、Masson、网状纤维、D-PAS特殊染色以及乙型肝炎表面抗原(HBsAg)、乙型肝炎核心抗原(HBcAg)免疫组化染色,观察并评价肝组织的炎症活动度、纤维化程度及HBsAg和HBcAg分布及表达模式.结果:84例患者中男∶女=2∶1,发病年龄0～35(19.01±7.54)岁;57.14%的患者有明确家族史;HBV DNA载量107～1010 copies/ml;炎症活动度及纤维化分期处于G0/S0者最多(51/84,60.71%),最少的为G1/S2和G2/S2,分别各占2.38%(2,84);不同炎症活动度及不同纤维化程度之间HBV DNA载量无明显差异(P>0.05);毛玻璃样肝细胞量与HBsAg表达量呈明显正相关(r=0.472,P=0.001),与HBcAg表达量无相关性(r=-0.005,P=0.973);肝组织内HBcAg的表达量较HBsAg多,且差异有高度统计学意义(P<0.01),HBcAg的表达以核型为主.结论:慢性乙型肝炎免疫耐受期患者病毒复制力强,虽然炎症及纤维化均呈静止状态,但仍有轻度的炎症及纤维化存在,应密切随访,警惕其进展.%Objective: To evaluate the clinicopathological features of chronic hepatitis B patienls in immune-tolerant phase. Methods: 84 patients with immune-tolerant CHB who had been diagnosed clinically and pathologically were involved in our study. Their serum HBV DNA level. serum HBV markers. and serum ALT, AST levels were tested. All specimens underwenl HE staining, special staining including Masson, reticular fibers. D-PAS and HBsAg, HBcAg immunohisto-chemical staining in order to evaluate liver tissue inflammation, fibrosis. the distribution and expression pattern of HBsAg and HBcAg. Results: Of 84 patients, male:female= 2:1, their age of onset was from 0-35 (19.01±7.549); 57.14％ of the patients had family history; HBV DNA level was 107-1010 copies/ml; there was no inflammation and fibrosis (G0/S0) in 60.71％ (51/84) patients, G1/S2 and G2/S2 only in 2.38％ (2/84) patients respectively; and fibrosis, there was no significant difference of HBV DNA level between different grades and different sLages (P＞0.05); the numhers of ground glass cell were significantly correlated to HBsAg expression (r=0.472. P=0.001), bul no correlated to HBcAg expression (r=-0.005. P=0.973);The expression of HBcAg in liver tissue were much more than HBsAg statistically (P＜0.01); the nuclear-type expression was dominated in the expression of HBcAg. Conclusion: The patients with immune tolerance have high HBV replication.Although the ALT level is normal and a majority patients have no evident histological changes, there is still mild inflammation and fibrosis in some patients. So a longer and closer monitor is needed for the patients in immune-tolerant phase.