丁型肝炎病人肝组织中HDAg和肝细胞凋亡双标记表达

目的 探讨肝细胞凋亡在丁型肝炎发病机制中的作用。方法 采用免疫经双重染色和ＴＵＮＥＬ技术，检测７９例丁肝病人肝组织ＨＤＡｇ和肝细胞凋亡分布及其关系，以５４例乙型肝炎病人肝组织作对照。结论 ＨＤＡｇ以肝细胞核表达为主，ＨＤＡｇ、凋亡细胞表达分布与肝组织病理损害程度一致（Ｐ〈０．０１），多数凋亡细胞位于ＨＤＡｇ阳性部位或附近，肝细胞凋亡在各型肝炎中的分布强度差别有显著性意义（Ｐ〈０．０１）。结论 ＨＤ     

妊娠合并急性脂肪肝的诊断和处理

妊娠期急性脂肪肝与重型肝炎是发生在妊娠晚期或产褥早期的严重而少见的致命性并发症。起病急骤，病情凶险，如对本病的早期症状和体征认识不足，延误诊断，就会造成母婴死亡。本文着重讨论妊娠期急性脂肪肝和重型肝炎的诊断及处理，以改善母儿的预后，获得良好的妊娠结局。     

纤维联接蛋白在乙型病毒性肝炎肝组织内的表达

用兔抗人纤维联接蛋白（ＦＮ）抗体经ＰＡＰ法染色，应用形态计量学方法对４５例乙型病毒性肝炎患者肝组织内ＦＮ的分布进行研究。结果表明，除慢性持续性肝炎组外，各型肝炎组肝小叶内ＦＮ含量均有所减少，其程度与肝炎时肝细胞变性、坏死程度相关。然而慢性持续性肝炎组、慢性活动性肝炎组及亚急性重型肝炎组门管区内ＦＮ含量与正常肝组比较均有所增多。ＦＮ沉积的增多与该区域内纤维结缔组织的增生相平行。     

重型病毒性肝炎肝组织内丙型肝炎病毒抗原表达的研究

目的：研究重型肝炎肝组织内丙型肝炎病毒（ＨＣＶ）抗原表达及特点，探讨ＨＣＶ感染在重型肝炎发生中的地位和作用。方法：用免疫组化法检测２０例重型肝炎组织内ＨＣＶ抗原。结果：肝组织内ＨＣＶ抗原表达阳性率４５％（９／２０），其中慢性重型肝炎６０％（６／１０），亚急性４２．９％（３／７），急性０％（０／３），ＨＣＶ抗原仅在肝细胞内表达，可呈胞浆均质型、包涵体型和膜下型，９例肝组织ＨＣＶ抗原表达阳性患者均混合     

重型乙型肝炎的病毒复制状况

为了解重型乙型肝炎时乙型肝炎病毒（ＨＢＶ）的复制状况，应用酶联免疫吸附实验和聚合酶链反应测定了５６例乙型肝炎病人的ＨＢＶ复制指标。慢性重型肝炎病人的ＨＢｅＡｇ和／或ＨＢＶ－ＤＮＡＰＣＲ阳性率明显低于非重型慢性肝炎（Ｐ＜０．０１），表明ＨＢＶ复制活跃不一定是重型肝炎发生的因素之一。进一步证明ＨＢＶ本身并无致肝细胞损伤作用     

肝细胞生长素治疗重型肝炎26例疗效观察

使用肝细胞生长素（ＨＧＦ）治疗重型肝炎２６例，并以同期综合治疗的２４例作对照。结果表明，治疗组在提高存活率、降低转氨酶、降低胆红素、改善凝血机理方面明显优于对照组（Ｐ＜０．０５）。提示，ＨＧＦ能促进肝细胞生长，治疗重型肝炎疗效满意。     

促肝细胞生长素治疗重型病毒性肝炎34例临床疗效观察

重型病毒性肝炎病情凶险，并发症多，治疗困难，预后极差，目前临床上主要采用综合治疗方法，但疗效尚不理想。我院于１９９４年４月至１９９８年１２月应用促肝细胞生长素（ＰＨＧＦ）治疗重型病毒性肝炎３４例，取得了较好的效果，现报道如下。１　临床资料１．１　病例选择　６２例均系我院１９９４年４月至１９９８年１２月同期住院患者，随机分为治疗组及对照组。其中治疗组３４例，男２４例，女１０例，年龄１８～６６岁，急性重型肝炎６例，亚急性重型肝炎８例，慢性重型肝炎２０例。对照组２８例，男１９例，女９例，年龄２０～６８岁，急性重型肝炎４例，亚急性重型肝炎６例，慢性重型肝炎１８例。两组重型肝炎按功能衰竭分期，其中早期：治疗组１０例，对照组４例；中期：治疗组１４例，对照组５例；晚期：治疗组１０例，对照组１９例。两组病例均符合１９９５年５月（北京）第五次全国传染病寄生虫病学术会议修订的诊断标准［１］，其中急性重型肝炎（急重肝）、亚急性重型肝炎（亚重肝）及慢性重型肝炎（慢重肝）的肝功能衰竭分期为：①早期：严重的全身及消化道症状，ＳＢ≥１７１μｍｏｌ／Ｌ，凝血酶原活动度（ＰＴＡ）≤４０％；②中期：有Ⅱ度肝性脑病或明显腹水，出血倾向（出血点或瘀...     

肝内HCAg阳性重型肝炎患者的免疫病理研究

目的 探讨丙型病毒性肝炎的发病机制。方法 在重型肝炎患者肝组织中用直接酶标法检测ＨＣｇ。结果 在９９例慢性重型肝炎患者的肝组织检测ＨＣＡｇ阳性９例（９．１％）;ＨＣＡｇ阳性的肝细胞呈单个散在分布或３～５个呈簇状分布,其表达方式分为三种：胞浆均质型（２／９）、包涵体型（４／９）、核型（３／９）。本组ＨＣＡｇ阳性肝细胞少量散在分布与肝细胞本身的病变无明显相关性,可见ＨＣＡｇ阳性肝细胞位于坏死灶的周边,     

急性重型肝炎肝细胞坏死及其增殖状况的研究

急性重型肝炎肝细胞坏死及其增殖状况的研究郎振为，李德芬，金荣华，孟忻我们采用免疫组织化学技术对３９例急性重型肝炎肝组织内增殖细胞核抗原（ＰＣＮＡ）进行了检测，以了解急性重型肝炎时肝细胞增殖能力及其增殖状况与预后的关系。一、资料和方法标本选自１９８３～...     

慢性重型肝炎肝内胆管增生的初步研究

目的：探讨CK7、8、19，白蛋白，甲胎蛋白AFP和CD34在慢性重型肝炎（CSH）患者肝组织内的表达；分析肝内胆管增生和肝再生的关系。方法：12例CSH肝组织行HE和嗜银染色；用SP免疫组织化学染色检测CK7、8、19，白蛋白、AFP和CD34表达。结果：死亡2例诊断为慢性重型肝炎；10例恢复期患者病理诊断为早期肝硬化。肝组织内胆管明显增生。肝组织内典型胆管增生细胞CK7、19强阳性；非典型胆管增生细胞CK8强阳性，CK7、19呈弱阳性，部分同时表达CK19和白蛋白，其细胞形态和表型符合肝卵圆细胞特征。结论：慢性重型肝炎患者肝组织内部分非典型增生胆管细胞可能来源于肝卵圆细胞；慢性重型肝炎患者肝细胞增生可能是干细胞参与的再生过程。     

HDV (delta factor) infection complicated with subacute fulminant hepatitis B. A morphological and immunohistochemical observation.

In 75 patients with subacute fulminant hepatitis B (SAFH), HDAg positive liver cells were observed in 14 cases (18.67%) by direct enzyme labelled method. It was found further that HDV (delta factor) infection was an important cause in producing massive necrosis of liver cells and superinfection of HDV with hepatitis B was identified as one of the causes of SAFH. This experiment also showed that the number of HDAg positive cells was in direct proportion to the area of liver necrosis. No obvious lymphocytic infiltrations and cytotoxic phenomena around the necrotic foci and HDAg positive cells could be found, while the cytoplasmic type HDAg positive cells showed distinct degeneration or even atrophy. Hence it was suggested that HDV could be a direct pathogenesis. No obvious characteristic changes in morphology of HDV infection could be found.

     

庚型肝炎病毒感染对重型肝炎发病的影响

目的 探讨庚型肝炎病毒感染在重型肝炎中的发病作用。方法 采用RT－PCR及EIA法检测重型肝炎患者血清HGVRNA及抗－HGV阳性情况，并与临床肝功、预后进行比较。结果 各临床类型重肝HGV感染率无明显差别，HGV感染病例ALT升高较低，SB、A／G较高，病死率显著低于HGV（－）病例，单纯HGV感染少见。结论 庚型肝炎病毒致病务弱，其感染不但未加重肝衰竭，反有利于肝衰竭的恢复。     

影响妊娠合并重型肝炎预后的单因素研究

目的 分析影响妊娠合并重型肝炎预后的单因素。方法 对66例妊娠合并重型肝炎患者预后的单因素进行回顾性分析。结果 ①不同临床分型的病死率不同,急性型最高,慢性型最低;②Tch、PTA降低、Scr升高及WBC≥10*109/L、"胆酶分离"现象、肝脏缩小均提示病死率升高;③随着肝性脑病、肝肾综合征、出血、感染等并发症的增多,病死率升高, 以上差异均有统计学意义。结论 临床分型、Tch、PTA、Scr、WBC、"胆酶分离"现象、肝脏缩小及并发症等是影响妊娠合并重型肝炎预后的重要因素,动态监测上述指标,积极防治各类并发症是提高临床救治成功率的重要措施。     

Acute and subacute fulminant hepatic failure: the role of liver transplantation

OBJECTIVES: To report the experience of the Australian National Liver Transplant Unit with patients with fulminant hepatic failure and to describe the role of liver transplantation. PATIENTS: Twenty-seven patients presented with acute or subacute fulminant hepatic failure during the period from January, 1986, to March, 1990. Twenty-two had acute and five had subacute fulminant hepatic failure. The causes were hepatitis B in 10 patients, presumed non-A, non-B (NANB) hepatitis in eight patients, drug-induced hepatic damage in five patients, and Wilson's disease in four patients. There were 13 males and 14 females. Ages were 2-43 years (mean, 23). Twenty patients (74%) were in grade IV encephalopathy on presentation. RESULTS: Six patients (22%) began to improve soon after admission and went on to full recovery. Spontaneous recovery was more frequent in patients with drug-induced hepatic damage (four patients [80%]) and was less frequent in those with hepatitis B (one patient [10%]) and NANB hepatitis (one patient [12%]). The other 21 patients (78%) were considered for orthotopic liver transplantation. Eight (30%) were judged to be unsuitable and went on to early death. Thirteen (48%) were suitable for transplantation. Of these five (19%) died before a liver donor became available and eight (30%) received liver grafts and went on to full recovery. Overall, 14 patients (52%) survived and 13 (48%) died. Patients with Wilson's disease (four [100%]) were most suitable for orthotopic liver transplantation whereas eight (44%) of those with hepatitis B or NANB hepatitis were unsuitable. Of the eight patients receiving liver grafts one had hepatitis B, three had NANB hepatitis and four had Wilson's disease. Five were in grade IV encephalopathy at the time of operation. The mean waiting time for transplantation was 6.4 days. Five patients received ABO blood group compatible grafts and three received ABO incompatible grafts. Of the latter group, two subsequently required secondary orthotopic liver transplantation with ABO compatible grafts. All eight patients who received transplants are alive and well 3-24 months after the operation. No patient has any neurological sequelae. CONCLUSIONS: Orthotopic liver transplantation is a preferred option for patients with fulminant hepatic failure whose condition is not responding to conservative management. ABO incompatible livers transplanted in emergency circumstances may prove life-saving either by functioning successfully or by providing time during which ABO compatible grafts become available.(ABSTRACT TRUNCATED AT 400 WORDS)     

Observation of T Lymphocyte Subsets in the Liver of Patients with Advanced Schistosomiasis and Advanced Schistosomiasis Accompanied with Hepatitis B

It has been demonstrated that severe liver damage and aggravated clinical manifestations and poorprognosis might take place in AS patients accompanied with hepatitis B[l--SJ. The status of cellular immune response in the liver, however, has not beenavailable in the literatures about the disease up tonow. In this study, T lymphocyte subsets in the liverwere detected by immunohistochemical technique inAS patients and those with AS accompanied withhepatitis B. The distribution of T lymphocyt…     

Hepatitis B virus infection in medical and health care personnel

Analysis of 51 cases of hepatitis B virus infection in health care workers admitted as patients to the liver unit over seven years showed three healthy carriers of hepatitis B virus, seven cases of fulminant hepatic persistent hepatitis, 17 cases of chronic active hepatitis (of whom 11 had cirrhosis), and five cases of hepatocellular carcinoma. To date 11 of these patients have died. Only 15 of the 51 patients had a history of direct occupational exposure and only three patients could recall specific inoculation injuries. In contrast, the source of infection was apparent in 32 of 50 consecutive cases of fulminant hepatic failure or acute hepatitis B in nonmedical staff. Since specific inoculation injuries are not the usual mode of infection ion medical staff and since only a few of the patients who are hepatitis B virus carriers will be detected by selective screening of "high-risk" patients, the overall risk of infection can be reduced only by stricter precautions in the handling of any patient's blood and by the use of hepatitis B virus vaccines for medical staff at high risk.     

慢性乙型肝炎免疫细胞NKG2D表达在肝病重型化中的作用

目的分析乙型肝炎免疫细胞NKG2D表达与肝病重型化的关系。方法应用免疫荧光技术和流式细胞术（FCM）分选20例慢性重型乙肝（FHB）、10例无症状表面抗原携带者（ASC）、10例健康对照的外周血NK细胞，并定量分析NKG2D表达。应用免疫组化SP法分析20例慢性乙肝（CHB）（轻度8例，其中G1级6例，G2级2例；中度7例，重度5例，其中G3级9例，G4级3例）、11例FHB肝组织内细胞毒细胞NKG2D的表达差异。结果经FACS可获得高纯度、高活性的NK细胞。FHB患者NK细胞的NKG2D蛋白表达量高于ASC和正常对照组，差异有显著性（P〈0．01）。免疫组化结果显示，FHB组肝脏免疫细胞NKG2D蛋白表达量分别高于CHB（G3、G4）组、CHB（G1、G2）组和正常对照组，差异有显著性（P〈0．01）。CHB（G3、G4）组高于正常对照组（P〈0．01），但CHB（G1、G2）组分别与CHB（G3、G4）组和正常对照组比较，差异无显著性（P〉0．05）。结论乙型肝炎外周血NK细胞和肝组织内细胞毒细胞NKG2D过度表达与重型肝炎发生相关。     

肝组织FasL表达与病程演变关系的研究

目的 通过研究凋亡相关分子FasL在肝组织的表达情况,探讨慢性乙型肝炎的发病机制.方法 以免疫组化方法检测68例慢性乙型肝炎的活检组织单核细胞、肝细胞以及肝窦细胞FasL表达情况.结果 FasL在浸润的单核细胞以及病变肝细胞的胞浆内高表达,其表达程度和肝组织炎症坏死程度正相关.结论 通过FasL-Fas机制介导乙肝病毒感染的肝细胞凋亡是慢性乙型肝炎发病及炎症活动的重要机制之一,FasL阳性肝细胞可能发挥细胞毒效应,发生自杀效应.     

亚急性重症肝炎与淤胆性肝炎黄疸成因的组织学差别

对29例亚急性重症肝炎及13例次淤胆性肝炎肝穿刺标本的光、电镜检查,测算了18例亚急性重症肝炎,9例淤胆性肝炎肝细胞内淤胆的容积百分比、胆汁凝固性坏死的容积百分比与临床资料进行统计学处理,指出这两类肝炎都有肝细胞内淤胆和胆汁凝固性坏死,但淤胆性肝炎肝小叶结构完整,胆汁流出道不破坏,亚急性重症肝炎肝小叶破坏。认为除肝细胞大量坏死外,胆汁流出道破坏是影响预后的另一个重要因素。本文详细描述了胆计凝固性坏死的超微结构改变。     

急性病毒性肝炎患者血浆氨基酸改变的临床意义

作者用高效液相色谱法测定28例急性肝炎患者的20种血浆氨基酸值。结果表明:急性肝炎患者17种氨基酸、重症肝炎患者13种氨基酸有显著增多;支链氨基酸(BCAA)/芳香族氨基酸(AAA)克分子比值显著降低。血浆氨基酸增多以蛋氨酸最为显著,在3例胆酶分离的重症肝炎患者蛋氨酸也明显升高,这可以作为反映肝细胞坏死程度的较好指标。讨论了肝炎患者血浆氨基酸代谢紊乱的机理和氨基酸测定的临床意义。