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目的探讨HBsAg对乙型肝炎病毒(HBV)感染相关性肝病患者病情进展的作用以及对癌变过程的影响,为临床提供科学依据。方法选择2009年12月-2013年8月390例行肝穿刺或手术切除的HBV感染肝病患者为研究对象,采用免疫组织化学的方法检测194例HBV慢性感染者、102例肝硬化(LC)和94例肝细胞癌(HCC)患者肝组织中HBsAg与Fas和其配体(FasL)的表达,并分析HBsAg与Fas、FasL表达的相关性。结果HBV的慢性感染者、LC和HCC患者肝组织中的HBsAg的表达阳性率分别为72.2%、60.2%和64.9%,FasL表达阳性率分别为39.2%、49.0%和58.5%,3组的阳性率和表达强度比较,差异无统计学意义;肝细胞中Fas表达阳性率分别为31.5%、17.4%和3.2%,肝内淋巴细胞中FasL表达阳性率分别为70.1%、57.1%和88.3%,其组间比较,差异无统计学意义,而其表达强度比较,差异有统计学意义(P<0.01),尤其是HCC患者的表达强度要显著的高于HBV慢性感染者,差异有统计学意义(P<0.01);HBsAg与Fas和FaSL表达强度存在相关性。结论 HBsAg对HBV感染相关性患者的各期均起了重要的作用,在早期主要通过增加肝细胞Fas表达从而诱导肝细胞凋亡的发生,使肝脏的炎症坏死加重,而在后期则主要增加肝细胞FasL表达以产生免疫逃避,这在肝细胞的癌变中起重要的作用。
Objective To investigate the effect of HBsAg on the progression of hepatitis B virus (HBV) -related liver disease and its effect on carcinogenesis and provide a scientific basis for clinical practice. Methods From December 2009 to August 2013, 390 patients with HBV-infected liver disease undergoing liver biopsy or surgical resection were enrolled in this study. 194 patients with chronic HBV infection, 102 with cirrhosis (LC) and 94 cases of hepatocellular carcinoma (HCC) patients with liver tissue HBsAg and Fas and its ligand (FasL) expression, and analysis of HBsAg and Fas, FasL expression. Results The positive rates of HBsAg in liver tissues of patients with chronic HBV infection, LC and HCC were 72.2%, 60.2% and 64.9%, respectively, and the positive rates of FasL expression were 39.2%, 49.0% and 58.5%, respectively The positive rate of Fas expression in hepatocytes was 31.5%, 17.4% and 3.2%, respectively. The positive rate of FasL expression in intrahepatic lymphocytes was 70.1%, 57.1% and 88.3%, respectively. There was no significant difference in the expression of Fas, There was no significant difference between the two groups (P <0.01), but the expression intensity of HCC patients was significantly higher than that of chronic HBV infected patients (P <0.01), the difference was statistically significant (P <0.01). There was a correlation between the expression of HBsAg and Fas and FaSL. Conclusions HBsAg plays an important role in all stages of HBV infection-related patients. In the early stage, hepatocyte apoptosis is induced mainly by increasing the expression of Fas in hepatocytes, leading to increased inflammation and necrosis in the liver, FasL expression of cells to produce immune escape, which plays an important role in the carcinogenesis of hepatocytes.