摘要
目的探讨婴儿巨细胞病毒(CMV)肝炎临床表现、肝脏病理学特征及肝细胞增殖和凋亡的情况。方法选择2008年9月至2018年9月在贵阳市妇幼保健院收治肝脏病理检查证实为CMV肝炎的患儿20例为观察组,同期选择20例黄疸原因待查入院患儿作为对照组。观察CMV肝炎临床特点、肝脏病理,采用免疫组织化学法及免疫荧光法检测2组患儿肝细胞增生及凋亡情况,同时检测肝组织中Fas mRNA的转录水平。结果婴儿CMV肝炎平均发病年龄(2.0±0.9)个月,1~2个月9例,2~3个月8例,≥3个月3例。临床多以反复肝功能异常[100%(20/20)]、黄疸[100%(20/20)]、肝脾大[65%(13/20)]、尿黄[75%(15/20)]、皮肤瘙痒[5%(1/20)]等为主要表现。肝脏病理均存在不同程度小叶炎症,以轻-中度为主,重度胆汁淤积5例,肝硬化2例。观察组患儿肝细胞增生核抗原(PCNA)阳性率为(10.17±4.81)%,对照组为(4.65±1.45)%;TUNEL凋亡检测中,观察组末端脱氧核苷酸转移酶(TdT)阳性率为(18.58±5.73)%,对照组为(3.31±1.02)%;2组PCNA、TdT阳性率比较,差异均有统计学意义(P<0.05)。观察组患儿肝细胞Fas mRNA的转录水平表达阳性率为(31.38±9.84)%,对照组为(13.24±5.19)%,2组比较,差异有统计学意义(P<0.05)。结论婴儿CMV肝炎临床表现缺乏特异性,发病以3个月内婴儿多见,1~2个月是感染高峰期,以肝组织轻-中度小叶炎症为主,存在肝细胞及毛细胆管胆汁淤积及纤维组织增生假小叶形成。肝细胞过度增殖,快速凋亡,增殖与凋亡存在动态失衡。Fas mRNA的转录水平增高与CMV感染有关。
Objective To investigate the clinical manifestations,pathological features,proliferation and apoptosis of hepatocytes of infantile cytomegaloviral virus(CMV)hepatitis.Methods Twenty children admitted to Guiyang Maternal and Child Health Care Hospital from September 2008 to September 2018 were selected as the observation group,during the same period,20 cases of hospitalized children with jaundice were selected as the control group.The clinical features and liver pathology of CMV hepatitis were observed.The hepatocyte proliferating nuclear antigen(PCNA)in both groups was detected by immunohistochemistry and immunofluorescence.Hepatocyte proliferation was observed by TUNEL,and immunohistochemical method was used to monitor the Fas mRNA expression level in liver tissue.Results The mean age of onset of CMV hepatitis in infants was(2.0±0.9)months,there were 9 cases aged 1-2 months,8 cases aged 2-3 months,3 cases aged greater than or equal to 3 months.The main clinical manifestations were repeated abnormal liver function[100%(20/20)],jaundice[100%(20/20)],hepatosplenomegaly[65%(13/20)],urine yellow[75%(15/20)],and itchy skin[5%(1/20)].The liver pathology there were different degree lobular inflammation,gave priority to with mild-moderate,severe cholestasis in 5 cases,2 cases of cirrhosis.The positive rate of proliferating cell nuclear antigen(PCNA)in the observation group was(10.17±4.81)%,the control group was(4.65±1.45)%,the positive rate of terminal deoxynucleotidyl transferase(TdT)in the observation group was(18.58±5.73)%,the control group was(3.31±1.02)%,the differences were statistically significant(P<0.05).The level of Fas mRNA expression in the liver cells of the observation group was(31.38±9.84)%,which was higher than that of the control group[(13.24±5.19)%],the difference was statistically significant(P<0.05).Conclusion Clinical manifestations of CMV hepatitis lack of specificity,1-2 months is the peak of infection,mild to moderate lobular inflammation of the liver tissue,liver cells and capillary bile d
作者
龙梅
朱莉
王潇
周光德
LONG Mei;ZHU Li;WANG Xiao;ZHOU Guangde(Department of Gastroenterology,Guiyang Maternal and Child Health Care Hospital/Guiyang Children′s Hospital,Guiyang,Guizhou 550003,China;Department of Pathology,PLA No.302 Hospital,Beijing 100039,China)
出处
《现代医药卫生》
2020年第4期509-511,515,共4页
Journal of Modern Medicine & Health
基金
贵州省科技厅社会发展研究处基金资助项目(黔科合SY字〔2012〕3131)
关键词
婴儿
肝炎
巨细胞病毒
肝脏病理
细胞增殖
细胞凋亡
Infant
Hepatitis
Cytomegalo virus
Liver tissue
Hepatocyte proliferation
Hepatocyte apoptosis
