肝硬化门脉高压患者肝动脉与门静脉病理变化分析

目的 研究肝硬化后门静脉高压病例大血管血管壁的组织结构改变,探讨诱导型一氧化氮合酶(iNOS)在肝硬化发生进程中的作用.方法 收集肝硬化肝移植病例的门静脉左支、左肝动脉和肝左静脉27例作为病例组,同期外伤性肝切除相应血管15例为对照组.分别予以HE染色、Masson染色,肝动脉加用弹力纤维染色和兔抗人 iNOS 多克隆抗体免疫组织化学. 结果 病例组门静脉内膜、中膜增厚,中膜平滑肌细胞增生、肥大,部分突出至内膜下;肝动脉内膜不规则增生,动脉管腔变窄,动脉壁内弹力膜变平、甚至断裂,中膜平滑肌向内膜增生;肝静脉壁组织结构没有明显改变.iNOS在肝动脉平滑肌细胞胞质呈高表达.结论 肝硬化患者肝动脉与门静脉血管壁会继发组织结构重建,这是人体自身代偿机制的结果,iNOS的高表达加速了该组织结构重建的发生、发展.

Analysis on pathological changes of portal vein and hepatic artery in patient with cirrhotic portal hypertension

Objective To research the tissue structure changes of vessels wall in the patients with liver cirrhotic portal hypertension and to investigate the role of inducible nitric oxide synthase (iNOS) in development process of liver cirrhosis.Methods The left portal vein,left hepatic artery and left hepatic vein (n=27) were collected from the patients with liver transplantation as the case group and the corresponding vessels of traumatic hepatectomy were collected as control group (n=15).HE staining and Masson staining were performed respectively.The hepatic arteries were stained with elastic fibers and immunized with anti-human iNOS polyclonal antibody.Results Compared with the control group,the portal vein intima and tunica media in the case group were thickened,the smooth muscle cells of tunica media were hyperplasia and hypertrophy,partial smooth muscle cells protruded into the intima;the irregular proliferation of hepatic arterial intima,arterial luminal stenosis,internal elastic membrane flatten,and even fracture,the tunica media smooth muscle hyperplasia to the intima were also observed;no obvious structural changes were observed in the hepatic vein wall.The higher expression of iNOS was found in the cytoplasm of hepatic artery smooth muscle cells (P<0.01).Conclusion The walls of liver artery and portal vein in the patients with liver cirrhosis would secondarily develop the tissue structure reconstruction,which is the results of human body′s own compensatory mechanism,the higher expression of iNOS accelerats the occurrence and development of the tissue structure reconstruction.