Sun Yan-ling, Zhao Jing-min, Zhou Guang-de, Wang Song-shan, Li Wen-shu, Meng Er-hong, Zhang Tai-he, Zhang Ling-xia, Chen Ju-mei, Zhu Chuan-lin, Pu Yu-shan
Department of Pathology, The No. 302 Hospital of PLA, Beijing 100039, China.
Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2003 Sep;17(3):270-3.
To explore the cut-off period of subclassification and pathological features of severe hepatitis (SH).
Based on combined clinical and pathological analyses, the complete clinical and biopsy or autopsy liver tissues data from 196 cases of patients with severe hepatitis were investigated. Meanwhile, proliferative hepatocytes, cholangioepithelia and collagens were identified by a panel of monoclonal antibodies such as those against albumin, cytokeratin 18,19 and collagen I, III with immunohistochemical method.
The clinical and pathological analyses indicated the cut-off periods of acute, subacute and chronic SH (ASH,SSH and CSH) were (13.4+/-7.2) d, (77.4+/-69.3) d and (80.5+/-63.2) d, respectively. Among all SH cases, one case of ASH patient presented clinical manifestation and pathological changes of ASH for 21 days, however, one patient with SSH was demonstrated 12 day course by histological examination. The time of cut-off period between ASH and SSH in child cases was shorter than that in adult cases. Histologically, ASH liver tissues showed massive and/or submassive necrosis caused by one attack, with congestive sinusoid frameworks and proliferative cholangioepithelium-like hepatocytes, while SSH liver tissues presented combined fresh and old submassive or massive necrosis caused by multiple attacks, accompanied by obviously proliferative bile ducts and sinusoid framework collapse.However, the pathological changes of CSH showed ASH- or SSH-like lesions on the background of chronic liver injury.
Our data indicated that the cut-off period between ASH and SSH is in accordance with the Scheme of Viral Hepatitis Prevention and Therapy, China, published in 2000, but excluded a part of child SH cases. In our study, the authors found a few pathological features in ASH and SSH.
探讨重型肝炎（SH）的亚分类截止期及病理特征。
基于临床与病理联合分析，对196例重型肝炎患者的完整临床及活检或尸检肝组织数据进行研究。同时，采用一组单克隆抗体，如抗白蛋白、细胞角蛋白18、19和I、III型胶原的抗体，通过免疫组化方法鉴定增殖的肝细胞、胆管上皮细胞和胶原。
临床及病理分析表明，急性、亚急性和慢性重型肝炎（ASH、SSH和CSH）的截止期分别为（13.4±7.2）天、（77.4±69.3）天和（80.5±63.2）天。在所有重型肝炎病例中，1例ASH患者出现ASH的临床表现及病理改变达21天，然而，1例SSH患者经组织学检查病程为12天。儿童病例中ASH与SSH的截止期时间短于成人病例。组织学上，ASH肝组织表现为一次发作导致的大片和/或亚大片坏死，伴有充血的窦状隙框架和增殖的胆管上皮样肝细胞，而SSH肝组织呈现多次发作导致的新鲜和陈旧性亚大片或大片坏死合并存在，伴有明显增殖的胆管和窦状隙框架塌陷。然而，CSH的病理改变表现为慢性肝损伤背景下的ASH或SSH样病变。
我们的数据表明，ASH与SSH之间的截止期与2000年发布的中国《病毒性肝炎防治方案》一致，但排除了一部分儿童重型肝炎病例。在我们的研究中，作者发现了ASH和SSH中的一些病理特征。
