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目的 研究散发性戊型肝炎 (HE)肝组织病理特征、病毒分布及复制 ,探讨戊型肝炎病毒 (HEV)致肝损伤机制。方法 对 36例发病急性期 (2 0例 )和恢复期 (16例 )穿刺肝组织 ,及 18例慢性乙型肝炎 (CHB)近期重叠HEV感染肝组织 ,作光、电镜组织学观察 ,原位杂交HEVRNA检测 ,Kupffer细胞免疫组化观察。结果 HE急性期肝组织病变有其相对特征 :易见肝细胞羽毛状变性(10 0 0 % )、毛细胆管内淤胆 (75 0 % )及双核、多核肝细胞 (65 0 % ) ,肝细胞凋亡小体偏大且不整 ,Kupffer细胞增生突出等。HEVRNA分布于肝细胞胞质近核周处 ,急性期肝组织HEVRNA阳性率(10 0 0 % )明显高于恢复期 (12 5 % ,P <0 0 0 1) ,且阳性肝细胞及病毒拷贝数较多 ,恢复期肝组织趋于复常。CHB重叠HEV感染者肝组织炎症活动度较单纯CHB为重。结论 散发性HE相对于其他病毒性肝炎有其病理学特征 ;HEV感染肝细胞并主要于发病急性期复制活跃 ;急性散发性HE恢复后转归良好 ;细胞免疫性肝损伤可能为HEV的主要致肝损伤机制 ,但不能排除存在病毒直接致肝损伤作用。
Objective To study the pathological features, distribution and replication of splenic hepatitis E (HE) in liver tissue and to explore the mechanism of hepatic injury induced by hepatitis E virus (HEV). Methods Thirty-six cases of acute liver injury (20 cases) and convalescent stage (16 cases) of liver tissue and 18 cases of chronic hepatitis B (CHB) recent overlap HEV infection of liver tissue for light and electron microscopy histological observation, in situ Hybridization HEV RNA detection, Kupffer cell immunohistochemistry observation. Results Hepatic lesions in the acute phase of HE had their relative characteristics: femoral degeneration of hepatocytes (100%), cholestasis of the bile ducts (75%), and binucleated, multicellular hepatocytes (65%), hepatocytes Apoptotic body is too large and irregular, Kupffer cell hyperplasia and so on. The distribution of HEVRNA in the proximal nucleus of hepatocytes was significantly higher than that in the recovery phase (100%, 100%), and the positive hepatocytes and virus copies A large number of convalescent liver tissue tend to normal. CHB overlap HEV infected liver activity than the CHB only heavy. Conclusions Sporadic HE has pathological features compared with other viral hepatitis. Hepatitis B virus (HEV) infection is mainly active in the acute phase of the onset of disease. The recovery of acute sporadic HE is good. The autoimmune liver injury may be the major cause of HEV Liver damage mechanism, but can not rule out the existence of the virus directly caused by liver injury.