检索历史 清除

目的:测量不同肝纤维化程度慢性肝病患者的肝脏整体与分叶体积，并观察患者肝脏微血管、肝细胞消亡与再生等病理改变，以期了解肝纤维化时肝脏宏观体积变化及其与肝组织微观病理的联系。方法:收集同时进行肝活检组织和腹部磁共振成像检查的慢性乙型肝炎、酒精性脂肪肝、自身免疫性肝病、非酒精性脂肪性肝病、药物性肝病的慢性肝病患者53例。采用Masson染色并根据Ishak肝纤维化分期，将患者分为肝纤维化早期（F1～2）、中期（F3～4）和晚期（F5～6）。应用ITK-SNAP软件测量肝脏和脾脏体积。通过CD31免疫组织化学染色反映肝内血管生成，Ki67与肝细胞核因子4α多重荧光免疫组织化学染色反映肝细胞再生，谷氨酰胺合成酶（GS）染色判断肝实质细胞消亡，原位末端标记法观察肝细胞凋亡。Spearman相关性分析肝体积变化与肝组织病理变化之间的关系。结果:随着肝纤维化进展，总肝体积和右肝叶体积逐渐降低（ P < 0.05），脾脏体积逐渐升高（ P < 0.05），CD31、GS的表达逐渐增加（ P < 0.05），Ki67的表达先升高后下降（ P < 0.05）。CD31阳性率与右肝叶体积（ r ＝-0.609, P < 0.001）和总肝体积（ r = ﹣0.363, P = 0.017）呈负相关。Ki67阳性率与右肝叶体积呈正相关（ r = 0.423, P = 0.018），凋亡细胞的阳性率与总肝体积呈显著负相关（ r = -0.860, P < 0.001）。GS阳性率与右肝叶体积呈负相关( r = ﹣0.440, P = 0.002)，肝细胞消亡数量与右肝叶体积呈负相关（ r = ﹣0.476， P = 0.013）。CD31阳性染色面积与Ki67阳性染色面积呈负相关（ r = ﹣0.511, P = 0.009）。 结论:随肝纤维化进展，患者总肝体积与右肝叶体积缩小，主要与肝组织中肝细胞减少与微血管紊乱有关。

Objective:To measure the overall and lobulated volume of the liver with different degrees of liver fibrosis and to further observe pathological changes such as liver microvasculature, hepatocyte apoptosis, and regeneration in order to understand the macroscopic volume changes of the liver during liver fibrosis and its relationship with liver tissue microscopic pathology in patients with chronic liver disease.Methods:53 patients with chronic hepatitis B, alcoholic fatty liver disease, autoimmune liver disease, nonalcoholic fatty liver disease, and drug-induced chronic liver disease who underwent both liver biopsy tissue and abdominal magnetic resonance imaging were collected. Patients were divided into early (F1-2), middle (F3-4), and late (F5-6) in accordance with the Ishak fibrosis stage and Masson stain. The liver and spleen volumes were measured using ITK-SNAP software. CD31 immunohistochemical staining was used to reflect intrahepatic angiogenesis. Ki67 and HNF-4α multiplex immunohistochemical staining were used to reflect hepatocyte regeneration. GS staining was used to determine parenchymal extinction lesions. TUNEL staining was used to observe hepatocyte apoptosis. Spearman correlation analysis was used to analyze the relationship between liver volume changes and liver histopathological changes.Results:As liver fibrosis progressed, the total liver volume and right lobe liver volume gradually decreased ( P<0.05), while the spleen volume gradually increased ( P<0.05). The expression of CD31 and GS gradually increased ( P<0.05), and the expression of Ki67 first increased and then decreased ( P<0.05). The positivity rate of CD31 was negatively correlated with the right lobe liver volume ( r=-0.609, P<0.001) and the total liver volume ( r=-0.363, P=0.017). The positivity rate of Ki67 was positively correlated with the right lobe liver volume ( r=0.423, P=0.018), while the positivity rate of apoptotic cells was significantly negatively correlated with the total liver volume ( r=-0.860, P<0.001). The positivity rate of GS was negatively correlated with the right lobe liver volume ( r=-0.440, P=0.002), and the number of PELs was negatively correlated with RV ( r=-0.476, P=0.013). The CD31 positive staining area was negatively correlated with the Ki67 positive staining area( r=-0.511, P=0.009). Conclusion:As liver fibrosis progresses, patients with chronic liver disease have a depletion in total liver volume and right lobe liver volume, and this is mainly in correlation with fewer liver cells and liver tissue microvasculature disorders.