【作者】 李鹏；

【导师】 党晓卫；

【作者基本信息】 郑州大学 ， 肝胆外科学， 2012， 硕士

【摘要】 目的：对比研究布-加综合征(Budd-Chiari syndrome, B-CS)和肝内型门静脉高压症(intrahepatic portal hypertension, IPH)患者手术前后肝脏组织病理学变化特征。方法：自2010年1月份至2010年12月,于患者行分流术中分别取肝脏组织少许(即术前,其中B-CS患者19例,IPH患者14例),术后6个月行肝穿刺取肝组织,利用免疫组化测定肝组织术前和术后肝脏Ⅳ型胶原(Collagen type Ⅳ,ColⅣ)、Ⅲ型前胶原(Procollagen Ⅲ,PCⅢ)、基质金属蛋白酶-1(Matrix metalloproteinase,MMP-1)和基质金属蛋白酶抑制因子-1(Tissue inhibitors of metalloproteinase,TIMP-1)的表达情况,并行HE染色观察肝组织形态学的差异。术中测量分流前后自由门静脉压力(Free portal pressure FPP)变化大小,并将其与肝脏纤维化程度进行相关分析。结果：B-CS组,手术后PCⅢ、ColⅣ和TIPM-1的表达均呈下降趋势(t=4.896,p=0.013；t=4.877,p=0.003；t=2.841,p=0.023),MMP-1手术前后表达差异无统计学意义(P>0.05),MMP-1/TIPM-1比值与肝纤维化程度无相关性(t=-0.710,p=0.504)。IPH组,手术前后上述四项指标表达差异无统计学意义(均P>0.05)；术前PCⅢ、ColⅣ及TIMP-1表达B-CS组与IPH组差异无统计学意义(均P>0.05),术后B-CS组上述指标下降趋势较IPH组明显(U=3.000,p=0.038；U=2.000,p=0.023；U=3.000,p=0.038)。HE染色显示：B-CS术前为淤血性、轻度炎性改变,色暗红,细胞肿胀,胞浆疏松化,部分气球样变,纤维化增生程度较轻；术后细胞形态及小叶结构呈现出明显的向正常结构可逆性转化的趋势。IPH术前肝组织色泽灰黄,肝小叶中-重度炎性改变,正常结构破坏,广泛纤维增生；术后无明显变化,可逆性不明显。B-CS及IPH组分流后FPP均明显下降(t=17.816,p=0.000；t=5.745,p=0.010),其中B-CS组FPP的下降对肝纤维化程度的逆转起关键性作用。结论：1.B-CS的基本病理病变是以肝窦淤血性,轻度炎性改变为主；IPH则表现为实质性肝纤维化。2.PCⅢ、ColⅣ及TIPM-1指标可反映出肝脏纤维化程度,对评估肝脏术后纤维化可逆性恢复有重要的意义。3.B-CS早期分流减压,降低门静脉压力,缓解淤血状态,可加快肝脏功能好转,促进纤维化逆转。更多还原

【Abstract】 ObjectiveComparative study of Budd-Chiari syndrome(B-CS) and Intrahepatic Portal hypertension (IPH) about the liver tissue pathology change, with the patients before and after surgery.MethodsFrom January2010to December2011, liver-biopsy was taken during shunt surgey (19B-CS patients,14IPH patients, before the surgery).6months after surgery,Collagen type IV (Col IV),Procollagen III (PC III)), Matrix metalloproteinase (MMP-1),Tissue inhibitors of metalloproteinase (TIMP-1) were tested using SABC (immuonohistochemistry) method. and HE staining to observe the morphological of liver tissue. Free portal vein pressure before and after shunt was measured. Test the variation range of the free portal pressure before and after shunt during the surgery, and analysis it with the degree of the liver fibrosis.ResultsIn B-CS group, Col IV, PC Ⅲ and TIPM-1expression were downregulated after surgery(t=4.896,p=0.013;t=4.877,p=0.003;t=2.841,p=0.023),MMP-1have no obvious correlation (P>0.05), while MMP-1/TIPM-1was not significantly correlated with liver fibrosis (t=-0.710,p=0.504). In IPH group, the expression of Col IV, PC III, TIPM-1and MMP-1/TIPM-1did not change significant after surgery(P>0.05). compared with that in IPH group the expression of ColIV, PCIII and TIPM-1downregulated significantly in B-CS group (U=3.000,p=0.038;U=2.000,p=0.023;U=3.000,p=0.038).By HE staining showed that, B-CS group experienced phonenomen-ons of congestion, mild silting hemorrhagic inflammatory changes, dark-red colored, cell swelling, loose cytoplasm, some ballooning degeneration, and slight fibrosis proliferation before surgery. Cell shape and lobular structure present obvious trend of reversible transformation to the normal structure; While for PHT group, color of the liver was gray yellow, and the liver experienced medium-severe silting hemorrhagic inflammatory change, the normal structure was damaged, and fiber grew extensively. No significant change was found after surgery, and reversibility was not obvious. FPP of B-CS and IPH were significantly decreased after shunt (t=17.816,p=0.000;t=5.745, p=0.010). Drop of FPP of B-CS group plays a key role in reversal of liver fibrosis.Conclusion1. The pathological lesions of B-CS is based on sinusoidal congestion, mild inflammatory changes mainly, while IPH is the performance of substantial liver fibrosis,its reversibility not significantly compared with the B-CS. 2. PCⅢ, ColⅣ and TIPM-1can reflect the liver fibrosis which has important implications for assessing liver fibrosis reversibility postoperatively.3. B-CS,early treatment to shunt decompessiom,reduce portal pressure and ease the congestion status can accelerate the improvement of liver function, and promote fibrosis reversal.更多还原