病毒性肝炎肝纤维化的临床与病理研究

为了解血清肝纤维化指标与临床及病理的关系，研究病毒性肝炎肝纤维化发生的机制，我们对４９例病毒性肝炎进行了肝组织病理学检查，并检测了其血清Ⅲ型前胶原（ＰＣⅢ）、Ⅲ型前胶原肽（ＰⅢＰ）、层粘蛋白（ＬＮ）、透明质酸（ＨＡ）以及Ⅳ型胶原（Ⅳ－Ｃ）等，同时对其肝组织进行了ＬＮ、Ⅳ－Ｃ、ａ－平滑肌肌动蛋白（ａ－ＳＭＡ）、细胞角蛋白（ＣＫ）等免疫组化研究。血清学检测结果表明，肝硬变慢性重型肝炎组，各项指标明显高于慢性肝炎组及急性肝炎组（Ｐ＜０．０１）。慢性肝炎组各项指标随着肝纤维化程度的加重，均有不同程度的升高，但以Ⅳ－Ｃ升高明显，重度（Ｓ４）患者显著高于轻度（Ｓ０～２）患者（Ｐ＜０．０１）。肝组织ａ－ＳＭＡ、Ⅳ－Ｃ、ＬＮ的表达亦随肝纤维化程度的加重逐渐明显。作者认为，肝纤维化的诊断应结合临床综合判定。

Clinical and pathological study on liver fibrosis in viral hepatitis

49 patients with viral hepatitis were studied on the correlationship between liver fibrosis and the level of serum precollagen type III (PC III), pre-collagen III pre-peptide (P III P), Laminin (LN), hyaluronic acid (HA) and collagen type IV (IV-C), as well as relationship between them and the expression of LN, IV-C, a-smooth muscle actin (a-SMA) and cytokeration (CK) in the liver tissues examined by immunohistochemistry. Results showed that the level of PC III, P III P, LN, HA and IV-C in the groups of liver cirrhosis and chronic severe hepatitis were higher than that in the groups of acute and chronic hepatitis. High correlation was found between the level of these markers (especially the level of the IV-C) and the degree of fibrosis in the group of chronic hepatitis. So were the expression of LN, IV-C, a-SMA and CK in the liver tissue. The results also showed that the liver fibrosis correlated with inflammatory reaction in the liver. So the authors suggested that more attention should be paid to the inflammatory reaction of the liver for prevention and treatment of liver fibrosis.