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目的 观察单磷酸阿糖腺苷治疗慢性乙型肝炎患者肝组织学变化。方法 采用肝组织损伤程度Knodell计分法、免疫组织化学及原位杂交法对 11例患者肝组织治疗前后的组织学进行比较。结果 治疗结束 6个月后 11例病人中有 8例病人的肝组织学得以改善 (肝组织学活动指数减少≥ 2分 ) ,其中肝组织小叶内炎症及纤维化程度较治疗前相比明显减轻 (P <0 .0 5 ) ;6例肝组织炎症活动度 (G)≥ 3者治疗后肝组织学活动指数有明显降低 (P <0 .0 5 ) ,而G≤ 2的 5例未见显著差异。免疫组化检测显示 ,治疗前肝组织中HBeAg阳性的 9例病人中 ,治疗后 4例阴转 ,活化的星状细胞数显著减少 (P =0 .0 18)。原位杂交检测HBVDNA显示 ,治疗前 9例阳性病人中治疗后 4例阴转。结论 单磷酸阿糖腺苷治疗慢性乙型肝炎可明显改善其肝组织学的炎症及纤维化程度
Objective To observe the changes of liver histology in patients with chronic hepatitis B treated with vidarabine monophosphate. Methods The degree of liver injury Knodell score method, immunohistochemistry and in situ hybridization of 11 patients before and after treatment of liver tissue histology were compared. Results Six months after the end of treatment, 8 of 11 patients improved hepatic histology (reduction of hepatic histological activity index ≥ 2 points). The degree of intrahepatic lobule inflammation and fibrosis was significantly reduced compared with those before treatment (P <0.05). The activity index of hepatic histology in 6 cases of hepatic inflammation activity (G) ≥ 3 was significantly decreased (P <0.05), while 5 cases of G≤2 were not found Significant differences. Immunohistochemical detection showed that in the 9 cases of HBeAg positive liver tissue before treatment, after treatment, 4 cases of negative conversion, activation of stellate cells was significantly reduced (P = 0.018). In situ hybridization detection of HBVDNA showed that 9 positive patients before treatment were negative after 4 treatments. Conclusion The treatment with adenosine monophosphate for chronic hepatitis B can obviously improve the degree of inflammation and fibrosis in liver tissue