慢性丙型肝炎肝细胞及细胞器病变特点研究

doi:10.3877/cma.j.issn.2095-1221.2019.02.008

中华细胞与干细胞杂志(电子版) ›› 2019, Vol. 09 ›› Issue (02) : 114 -118. doi: 10.3877/cma.j.issn.2095-1221.2019.02.008

论著

慢性丙型肝炎肝细胞及细胞器病变特点研究

刘庆宏¹, 余宏宇²^,^†(

), 吴丽霞³, 延永琴¹

^1. 350025　福州，中国人民解放军海军军医大学福州临床医学院（解放军联勤保障部队第900医院病理科）
^2. 200003　上海，中国人民解放军海军军医大学（第二军医大学）附属长征医院病理科
^3. 350025　福州，福建医科大学孟超肝胆医院病理科

收稿日期:2019-02-26 出版日期:2019-04-01
通信作者: 余宏宇
基金资助:
解放军联勤保障部队第九〇〇医院院内课题(2014Q14)

Characteristics of hepatocyte and organelle lesions in viral hepatitis C

Qinghong Liu¹, Hongyu Yu²^,^†(), Lixia Wu³, Yongqin Yan¹

^1. Department of Pathology, Fuzhou Clinical Medical College of the PLA Naval Medical University (Department of Pathology, The 900th Hospital of Joint Logistic Support Force, PLA), Fuzhou 350025, China
^2. Department of Pathology, Chang Zheng Hospital, Naval Medical University (The Second Military Medical University), Shanghai 200003, China
^3. Department of Pathology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China

Received:2019-02-26 Published:2019-04-01
Corresponding author: Hongyu Yu

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目的

观察不同炎症程度的丙型肝炎肝细胞及细胞器超微结构，了解不同炎症程度的丙型肝炎患者肝细胞超微结构特征。

方法

收集6例经肝穿刺活检病理确诊的轻度、中度、重度丙型肝炎肝组织标本各2例，同时选取2例肝移植中的正常供肝组织作为对照，对照光镜特点，对各病例电镜下的肝细胞器超微结构特点进行分析总结。

结果

光镜下观察到轻度慢性丙型肝炎以肝细胞水肿变性为主；中度慢性丙型肝炎以汇管区炎症为主伴淋巴滤泡形成；重度慢性丙型肝炎肝小叶内易见肝细胞点状坏死，纤维组织增生并可见弓形纤维或假小叶形成。电镜下观察到与正常肝细胞相比较，轻度慢性丙型肝炎病例中肝细胞胞浆内粗面内质网减少、滑面内质网增多；中度慢性丙型肝炎表现为肝细胞胞浆内脂滴稍增多，部分伴脂滴融合，胞浆内局灶可见胶原纤维；而重度慢性丙型肝炎的肝细胞内可见线粒体凝聚、融合和变性，糖原增多，脂滴进一步呈大泡型脂变并融合，细胞核内可见包涵体形成。

结论

不同炎症程度的丙型肝炎肝细胞具有不同的超微结构特征。

关键词: 肝穿刺活检, 慢性丙型病毒性肝炎, 电子显微镜, 超微结构

Objective

To observe the ultrastructure of hepatocytes and organelles of hepatitis C patients with different degrees of inflammation, and to summarize the ultrastructure characteristics of hepatocytes of hepatitis C patients with different degrees of inflammation.

Methods

Six cases of mild/moderate/severe hepatitis C liver tissue samples (2 cases each) confirmed by liver biopsy pathology were collected, and the normal donor liver tissues in 2 cases of liver transplantation was selected as a negative control. The characteristics of light microscope were compared, and the ultrastructure characteristics of liver organelles under an electron microscope in each case were summarized.

Results

Light microscope observation: mild chronic hepatitis C was mainly caused by hepatocyte edema and degeneration. Moderate chronic hepatitis C is characterized by portal inflammation with lymphatic follicular formation. In severe chronic hepatitis C, the hepatic lobules are prone to spotty necrosis of hepatocytes, hyperplasia of the fibrous tissues and formation of arcuate fibers or pseudo lobules. Electron microscopic observation: compared with the normal hepatocytes, rough endoplasmic reticulum was decreased and smooth endoplasmic reticulum was increased in the cytoplasm of hepatocytes in mild chronic hepatitis C patients. Moderate chronic hepatitis C was characterized by slight increase of lipid droplets in the cytoplasm of liver cells, partial lipid droplet fusion, and focal collagen fibers in the cytoplasm. In the hepatocytes of severe chronic hepatitis C, mitochondrial aggregation, fusion and degeneration could be seen, glycogen was increased, and lipid droplets were further vesicular lipid degeneration and fusion. Inclusion body formation could be seen in the nucleus.

Conclusion

HCV hepatocytes with different degrees of inflammation have different ultrastructural characteristics.

Key words: Liver biopsy, Chronic viral hepatitis, Electron microscopy, Ultrastructure

图1 光镜和透射电镜下观察轻度慢性丙型肝炎组织结构注：a图为轻度慢性丙型肝炎（HE染色，×200）；b图为网纤+Masson染色×200；c图为轻度慢性丙型肝炎肝细胞水肿变性明显（铀、铅染色，×20 000）；d图为轻度慢性丙型肝炎肝细胞胞浆内粗面内质网减少、滑面内质网增多（枸橼酸铅、醋酸铀染色，×25 000）

图2 光镜和透射电镜下观察中度慢性丙型肝炎组织结构注：a图为中度慢性丙型肝炎（HE染色，×200）；b图为汇管区纤维组织增生（网纤+Masson染色，×200）；c图为中度慢性丙型肝炎见纤维组织增生（铀、铅染色，×20 000）；d图为中度慢性丙型肝炎肝细胞内浆内脂滴稍增多伴部分脂滴融合（枸橼酸铅、醋酸铀染色，×20 000）

图3 光镜和透射电镜下观察重度慢性丙型肝炎组织结构注：a图为重度慢性丙型肝炎光镜（HE染色，×200）；b图为弓形纤维形成（网纤+Masson染色，×200）；c图为重度慢性丙型肝炎肝细胞中可见高尔基复合体破碎，线粒体凝聚、变性、肿胀融合（铀、铅染色，×12 000）；d图为糖原增多，可见核内包涵体（枸橼酸铅、醋酸铀染色，×25 000）

图4 电镜下观察对照组正常肝组织结构（枸橼酸铅、醋酸铀染色，×40 000）

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Characteristics of hepatocyte and organelle lesions in viral hepatitis C

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