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目的 :从病理角度探讨我国现行的急性、亚急性重型肝炎的时限划分是否能与国际接轨 ,以及急性重型肝炎是否存在病理亚型。方法 :对比国内外有关资料 ,对北京地坛医院 4 8例急性和 79例亚急性重型肝炎的肝穿刺病理切片作重点观察。结果 :从时间上看 ,我国的急性重症肝炎 (<10d)与亚急性重症肝炎的急性期 (10d～ 30d)分别相当于国外急性肝衰竭中的超急性及暴发性亚型 ;如将我国亚急性重症肝炎中的急性期归入急性重症肝炎 ,则不论时限划分还是病理变化均与国际一致。急性重型肝炎的主要病变为肝细胞的急性广泛坏死(大块、亚大块或桥接坏死 ) ,坏死 >2 / 3者 ,多不能存活 ;如坏死≤ 1/ 2 ,存活肝细胞虽有变性 ,经及时治疗 ,再生迅速 ,多数可望修复 ,年轻者预后尤佳。结论 :我国重型肝炎的病变规律与国际上一致 ,不难接轨 ;急性重型肝炎不存在水肿亚型 ,其坏死范围的大小直接影响预后。
OBJECTIVE: To explore whether the time-limit division of current acute and subacute severe hepatitis in China can be in line with international standards and whether pathological subtypes exist in acute severe hepatitis from the pathological point of view. Methods: Comparing the relevant data at home and abroad, 48 cases of acute and 79 cases of subacute severe hepatitis liver biopsy in Beijing Ditan Hospital were observed. Results: From a time point of view, acute acute hepatitis (<10d) and acute subacute severe hepatitis (10d ~ 30d) in China are respectively equivalent to hyperacute and fulminant subtypes in acute liver failure abroad. For example, Acute severe hepatitis in the acute phase of acute severe hepatitis, regardless of the time limit or pathological changes are consistent with the international. Acute severe hepatitis, the main lesion of acute extensive necrosis of hepatocytes (large, sub-chunk or bridge necrosis), necrosis> 2/3, and more can not survive; such as necrosis ≤ 1/2, although the survival of liver degeneration, After timely treatment, rapid regeneration, most are expected to be repaired, especially young prognosis. Conclusion: The pathological changes of severe hepatitis in China are consistent with those in the world. It is not difficult to get along with the pathology of acute hepatitis. There is no edema subtype in acute severe hepatitis, and the size of the necrosis range directly affects the prognosis.