摘要
目的分析不同肝损伤基础上慢性乙型重型肝炎（chronic severe hepatitis B,CSHB）与肝衰竭类型的对应关系。方法回顾性研究91例CSHB临床和病理资料,按其发病前肝损伤基础为慢性HBV携带（HBC）、慢性乙型肝炎（CHB）和肝硬化（LC）分组,分析各组患者表现的肝衰竭类型、临床特点和病理特点。结果 91例CSHB患者男74例,女17例,平均（40.6±11.2）岁,发生在HBC、CHB、LC基础上分别占9.9%、7.7%和82.4%,HBC组年龄明显低于另两组。各组肝衰竭类型均以亚急性为主,发生肝衰竭时间为15~150天,平均（42.2±30.6）天,以高黄疸、腹水为突出特点。常见诱因为劳累、重叠感染、药物性及酒精性肝损伤。不同肝损伤基础CSHB的PTA、TBiL无差异,ALB、CHE、CHO三组依次降低,肝硬化组最低,HBV-DNA定量则为HBC组高于LC组。HBC和CHB基础上的CSHB肝脏病理表现主要为大块或亚大块坏死,病变较均匀,与无慢性肝病基础的急性/亚急性重型肝炎的病理并无显著差异,CHB基础上者出现广泛坏死时极易掩盖原有病变,Masson染色可显示汇管区周围纤维化。肝硬化基础上者病变不均一,大块或亚大块坏死的同时总有部分结节保留,不同部位坏死范围及新旧程度不一。结论我国CSHB多发生于肝硬化基础上,其对应肝衰竭类型为慢加急/亚急性肝衰竭,而发生在HBC和CHB基础上的CSHB则属于急性或亚急性肝衰竭。
Objective To assess if CSHB based on different liver injury extent can meet the international definition of acute-on-chronic liver failure（ACLF） criteria.Methods A total of 91 patients with CSHB were involved in the study.Their clinical findings,laboratory data and liver pathology features were retrospectively analyzed and grouped by hepatitis virus B carrier state（HBC）,chronic hepatitis（CHB） or liver cirrhosis（LC） before they started liver failure.Results Of the 91 patients,74 were male and 17 were female,mean age was（40.6±11.2） years old,based on HBC,CHB,LC with 9.9%,7.7% and 82.4%,respectively.Ages of HBC group were most young.Most cases presented sub-acute liver failure with high jaundice and ascites.Predisposing factors included exertion,superinfection,drugs or alcholic injury.There was no difference in PTA and TBiL,but ALB,CHE,CHO decreased gradually with liver disease deteriorated,while serum HBV-DNA level was higher in HBC group than that in LC group.The livers showed massive or submassive necrosis in HBC and CHB group,most like acute/subcute severe hepatitis without HBV infection previously.The characteristics of LC group were necrosis of all the hepatocytes in some nodules while other nodules were intact or only patchy necrosis of the parenchyma,diaparity existed in slides,which was the major difference in histopathology change with HBC and CHB group.Conclusion There is no unanimity in classification of CSHB with the type of liver failure.We recommend CSHB underlying HBC and CHB are identical to acute/subacute liver failure,while acute episode on cirrhosis belongs to ACLF.
出处
《胃肠病学和肝病学杂志》
CAS
2010年第5期399-403,共5页
Chinese Journal of Gastroenterology and Hepatology
基金
"艾滋病和病毒性肝炎等重大传染病防治"科技重大专项("十一五")资助项目(2008ZX10002-005-3)
国家重点基础研究计划"973"资助项目(2007CB512801)
关键词
慢加急性肝衰竭
肝脏病理
慢性乙型重型肝炎
Acute-on-chronic liver failure
Liver pathology
Chronis severe hepatitis B
