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目的探讨代偿期肝硬化的临床与病理的关系,肝硬化病理特点发生发展过程的动态变化,以及对泰来肽治疗的反应。方法对近30年来本科住院治疗的代偿期肝硬化548例(均经肝活检证实)进行了重复肝活检,其中325例2次以上。肝组织切片进行HE染色和改良网织染色检查。肝组织内病毒抗原采用免疫组织化学检查,血清病毒标志物和病毒基因分别采用ELISA法和PCR法检查。所有病例住院治疗3～18个月,平均6个月。绝大多数病例采用泰来肽治疗,2～8ml每日1次注射,部分病例采用泰来肽与拉米夫定联合治疗,疗程均为3个月。结果临床治愈72.9%,基本治愈11.4%,好转14.3%,ALT复常率98.6%,蛋白代谢复常率68.6%,肝组织病理前后两次对照,大部分病例显著进步,由肝硬化逆转为中度和轻度慢性肝炎患者分别占68.4%和34.6%,血清HBsAg和HBeAg阴转率分别为7.5%和51.2%。结论肝硬化的病理特征经适当治疗可以逆转,泰来肽具有良好的抗炎和抗纤维化作用。
Objective To investigate the relationship between clinical and pathological changes of compensated cirrhosis, the dynamic changes of pathological features of liver cirrhosis, and the response to the treatment of thalidomide. Methods Reexamined liver biopsy was performed in 548 patients with decompensated cirrhosis undergoing hospitalization in the past 30 years (confirmed by liver biopsy), of which 325 cases were more than twice. Hematoxylin-eosin (HE) staining and modified mesh staining were performed on liver sections. Immunohistochemistry was used to detect the viral antigens in liver tissue. Serum viral markers and viral genes were examined by ELISA and PCR. All cases hospitalized 3 to 18 months, an average of 6 months. The vast majority of cases treated with thalidomide, 2 ~ 8ml 1 injection daily, in some cases the use of telamin and lamivudine combination therapy, treatment were 3 months. Results The clinical cure rate was 72.9%, the basic cure rate was 11.4%, the improvement rate was 14.3%, the ALT recovery rate was 98.6%, the protein metabolism recovery rate was 68.6%. The pathological changes of liver tissues both before and after treatment showed significant improvement in most cases from cirrhosis to Patients with degrees and mild chronic hepatitis accounted for 68.4% and 34.6% respectively, and the seroconversion rates of serum HBsAg and HBeAg were 7.5% and 51.2% respectively. Conclusion The pathological features of cirrhosis can be reversed by proper treatment. Tailai peptide has good anti-inflammatory and anti-fibrosis effects.