慢性乙型肝炎患者肝细胞凋亡的研究

摘要

Objective To investigate the relationship between hepatocyte apoptosis and the level of inducible nitric oxide synthase (iNOS) in hepatic tissue in the patients with chronic hepatitis B(CHB). Methods We observed 37 eases with CHB and 10 normal controls. Transferase-mediated-UTP-biotin nick-end labling (TUNEL) technique was used to detect apoptosis ceils and immunohistochemical staining were also performed to investigate the expression of inducible nitric oxide synthase (iNOS) in biopsy samples. The serum level of ALT,HBV DNA,grading of necreinflammatory activity and staging of fibrosis were also assessed. Results Hepatocytes in all CHB liver tissues were positively stained by TUNEL in various degree. In contrast,control tissues did not show DNA fragmentation. A significant correlation was seen between apeptosis index (AI) and neeroinflammatory grading ( r = 0.404,P = 0.015) and serum iNOS level( r = 0.465,P = 0.004). It did not correlate with fibrosis stage and serum alanine aminotransferase level. Conclusion The oxidative stress in patients with CHB may reflected the apoptosis of hepatocyte. Apoptosis involves in liver injury of CHB,but with no significant correlation to serum level of ALT.%目的 探讨慢性乙型肝炎(CHB)患者肝细胞凋亡与肝组织诱导性一氧化氮合酶(iNOS)、肝脏病理及血清转氮酶水平之间的相关关系.方法 取37例CHB患者和10例正常对照,采用dUTP缺口末端标记技术(TUNEL)检测肝组织中的细胞凋亡情况,免疫组化法检测肝组织iNOS的表达,并常规测定患者肝组织炎症分级和纤维化分期、血清丙氨酸转氨酶(ALT)、HBV DNA水平.结果 所有CHB患者的肝组织中均见到不同程度的TUNEL染色阳性.正常对照肝组织中未见到TUNEL阳性肝细胞.在CHB肝组织中,凋亡指数(A1)与炎症分级(r=0.404,P=0.015)及肝组织iNOS水平(r=0.465,P=0.004)明显相关并有统计学意义,而与血清ALT水平、HBV DNA以及组织学纤维化分期无明显关系.结论 慢性乙型肝炎患者体内氧化应激水平可能是肝细胞凋亡的诱导因素之一,细胞凋亡参与了CHB的肝细胞损伤过程,但并不影响患者的生物化学指标.