Enzan H, Himeno H, Iwamura S, Saibara T, Onishi S, Yamamoto Y, Miyazaki E, Hara H
Department of Pathology, Kochi Medical School, Japan.
Virchows Arch. 1995;426(1):95-101. doi: 10.1007/BF00194703.
To examine the relationship of Ito cells to postnecrotic liver fibrosis, liver specimens, obtained at autopsy from 17 patients with acute massive necrosis (AMN) and acute submassive hepatic necrosis (ASMN), were examined immunohistochemically. In normal adult livers, Ito cells positive for alpha-smooth muscle actin isoform (ASMA) were rarely seen, scattered along hepatic sinusoids. In contrast, in AMN the Ito cells in necrotic areas became strongly positive for ASMA. They were swollen with elongated cytoplasmic processes along collapsed sinusoidal walls. Around these ASMA-positive Ito cells, there were numerous infiltrated macrophages and lymphocytes present. There was no significant alteration of fibroblasts in the portal tracts. In the middle and late stages of ASMN, the spindle-shaped ASMA-positive Ito cells formed a continuous cellular network. New fibre formation was predominantly around them. In this immediate postnecrotic fibrosis, ASMA-positive stromal cells of Ito cell origin were distributed irregularly and were closely associated with reticulin and newly-formed collagen fibres. Regenerative nodules were surrounded by dense layers of ASMA-positive stromal cells. Throughout the stages of ASMN, portal fibroblasts remained negative for ASMA. We believe that Ito cells in necrotic areas show myofibroblastic transformation and play a central role in the postnecrotic liver fibrosis. Portal fibroblasts play no significant part in this type of fibrosis.
为研究肝星状细胞与坏死性肝纤维化的关系，我们采用免疫组织化学方法检测了17例急性大块坏死（AMN）和急性亚大块肝坏死（ASMN）患者尸检获得的肝脏标本。在正常成人肝脏中，α平滑肌肌动蛋白异构体（ASMA）阳性的肝星状细胞很少见，沿肝血窦散在分布。相比之下，在AMN中，坏死区域的肝星状细胞ASMA呈强阳性。它们肿胀，胞质突起沿着塌陷的血窦壁伸长。在这些ASMA阳性的肝星状细胞周围，有大量浸润的巨噬细胞和淋巴细胞。门管区的成纤维细胞无明显改变。在ASMN的中晚期，梭形的ASMA阳性肝星状细胞形成连续的细胞网络。新纤维形成主要围绕它们。在这种坏死性肝纤维化的早期，ASMA阳性的源自肝星状细胞的基质细胞分布不规则，与网状纤维和新形成的胶原纤维密切相关。再生结节被ASMA阳性基质细胞的致密层包围。在整个ASMN阶段，门管区成纤维细胞ASMA仍为阴性。我们认为，坏死区域的肝星状细胞表现出肌成纤维细胞转化，并在坏死性肝纤维化中起核心作用。门管区成纤维细胞在这种类型的纤维化中不起重要作用。
