老年男性2型糖尿病患者肝脏汇管区病理形态学观察

目的 研究老年男性2型糖尿病(type 2 diabetes mellitus,T2DM)患者肝脏汇管区病理形态学改变.方法 选择103例T2DM患者为糖尿病组,48例同年代、性别、同年龄组非糖尿病患者为对照组.观察尸体解剖肝脏标本中汇管区病理形态学改变.应用组织化学及免疫组织化学方法 对肝脏汇管区组织学改变进行研究.结果 103例老年男性T2DM患者汇管区变化:(1)微血管病变:小叶间动脉(微动脉,管腔直径<100 μm)内膜内皮细胞脱落、嗜伊红物质沉积、内膜偏心性增厚,管腔狭窄;中膜平滑肌增生、平滑肌细胞向内膜下迁移;外膜纤维组织增生.T2DM组62.1 oA(64/103)患者出现微血管病变,与对照组16.7%(8/48)比较差异有统计学意义(χ2=27.14.P<0.01).(2)玻璃样变的胶原纤维组织在小叶间动脉、静脉及小叶间胆管周沉积,使汇管区扩大,最终使汇管区三联管萎缩、消失,形成硬化的汇管区.有65.0%(67/103)患者出现汇管区变化,与对照组14.6%(7/48)比较差异有统计学意义(χ2=23.27,P<0.01).(3)终末汇管区显著.结论 老年男性T2DM患者汇管区出现微血管病变,并可使胶原纤维组织增生,汇管区三联管萎缩,形成硬化汇管区.

Study on histopathological changes of hepatic portal area in elderly men with type 2 diabetes mellitus

Objective To study the histopathological features of hepatic portal area in autopsy specimens of elderly men with type 2 diabetes mellitus (T2DM).Methods One hundred and three autopsy cases with T2DM (diabetic group) and contemporary 48 non-diabetic cases matched by gender and age (control group) were selected in the study.The histopathological changes of hepatic portal area were observed by histochemical and immunohistochemical methods.Results (1) In diabetic group, endothelial denudation, eosinophilie deposits, eccentric intimal thickening and luminal stenosis were found in hepatic interlobular artery (arteriole, the lumen diameter < 100 μm).The medial smooth muscle cells proliferated and migrated into intima, and fibroplasia occurred in adventitia.62.1% (64/103) of the patients with T2DM had microangiopathy and there was statistically significant difference between the two groups (χ2= 27.14, P< 0.01 ).(2) Hyaline collagen fiber tissues deposited around interlobular artery, interlobular vein and interlobular bile ducts, resulting in enlargement of the portal area and the secondary atrophy and disappearance of portal triad.65.0% (67/103) of the patients with T2DM had this pathological changes in the portal area and there was statistically significant difference between the two groups(χ2= 23.27,P<0.01).(3) Terminal portal area was notable.Conclusions Mieroangiopathy can be observed in the hepatic portal areas of elderly men with T2DM, which may induce the fibrotic tissue hyperplasia, the atrophy of the portal triad and the sclerosing portal area.