Mason A L, Wick M, White H M, Benner K G, Lee R G, Regenstein F, Riely C A, Bain V G, Campbell C, Perrillo R P
Gastroenterology Section, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.
Gastroenterology. 1993 Jul;105(1):237-44. doi: 10.1016/0016-5085(93)90032-8.
Recurrent hepatitis B after liver transplantation may be complicated by fibrosing cholestatic hepatitis. This syndrome is associated with rapid graft failure and is characterized by ballooning degeneration of hepatocytes and abundant viral antigen expression.
To study this disorder further, in situ hybridization studies were performed on 36 liver biopsy specimens from 14 transplanted patients with recurrent hepatitis B and 18 nontransplanted controls with chronic hepatitis B. Biopsy specimens were scored for histological features and intensity of riboprobe hybridization signal to hepatitis B virus (HBV) DNA and RNA.
HBV DNA hybridization signals of 2+ to 3+ intensity were observed in 53% of the posttransplant biopsies but none of the nontransplanted samples (P < 0.001). HBV RNA signals of this intensity were found in 42% of the transplant biopsy specimens compared with 17% of the nontransplant specimens (P < 0.07). Features of fibrosing cholestatic hepatitis were noted in 12 biopsies; 11 of these displayed RNA signals of 2+ to 3+ intensity (92%) compared with 4 of 24 (17%) biopsy specimens without this diagnosis (P < 0.001). The level of hepatocyte RNA correlated with the extent of hepatocellular ballooning (P < 0.007).
These data suggest that fibrosing cholestatic hepatitis is associated with enhanced hepatitis B virus transcription and support a cytopathic role for the virus in the development of this syndrome.
肝移植后复发性乙型肝炎可能并发纤维性胆汁淤积性肝炎。该综合征与移植肝快速衰竭相关，其特征为肝细胞气球样变性和大量病毒抗原表达。
为进一步研究该疾病，对14例移植后复发性乙型肝炎患者的36份肝活检标本以及18例慢性乙型肝炎非移植对照者的标本进行原位杂交研究。对活检标本的组织学特征以及针对乙型肝炎病毒（HBV）DNA和RNA的核糖探针杂交信号强度进行评分。
移植后活检标本中53%观察到强度为2+至3+的HBV DNA杂交信号，而未移植标本中均未观察到（P<0.001）。该强度的HBV RNA信号在42%的移植活检标本中发现，而非移植标本中为17%（P<0.07）。12份活检标本中发现有纤维性胆汁淤积性肝炎特征；其中11份显示强度为2+至3+的RNA信号（92%），相比之下，未诊断为此病的24份活检标本中有4份（17%）出现该信号（P<0.001）。肝细胞RNA水平与肝细胞气球样变程度相关（P<0.007）。
这些数据表明纤维性胆汁淤积性肝炎与乙型肝炎病毒转录增强相关，并支持该病毒在该综合征发生中起细胞病变作用。
