肝衰竭的临床病理基础

蒋丽娜; 赵景民

doi:10.3969/j.issn.1001-5256.2019.09.005

肝衰竭的临床病理基础

DOI: 10.3969/j.issn.1001-5256.2019.09.005

解放军总医院第五医学中心病理诊断与研究中心

基金项目:

国家自然科学基金青年项目(81500450);国家自然科学基金面上项目(81673654)；

详细信息

中图分类号: R575.3
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出版历程
- 收稿日期: 2019-08-01
- 出版日期: 2019-09-20

Clinicopathological basis of liver failure

Center for Pathological Diagnosis and Research, The Fifth Medical Center of Chinese PLA General Hospital

Research funding:

摘要

摘要: 肝衰竭是由严重的合成和代谢紊乱导致的一组肝细胞功能障碍性疾病,病死率高。组织病理学对肝衰竭的诊断、分型及预后判断临床意义重大。广泛的肝细胞死亡与肝细胞再生贯穿肝衰竭的临床病理过程,肝细胞的死亡方式以坏死为主,且与细胞凋亡、焦亡及自噬等细胞死亡方式并存。各型肝衰竭有其相对的病理学特征,急性肝衰竭强调的是一次性打击导致的一致性大块性或亚大块性坏死,亚急性肝衰竭系多次打击引起的新旧病变交杂的亚大块或杂以大块性肝坏死,慢加急性肝衰竭是在慢性肝病背景基础上发生的一次或多次打击导致的广泛肝细胞坏死,慢性肝衰竭组织学上呈小结节或大小结节混合性肝硬化,纤维间隔以Ⅰ型胶原为主的致密宽隔,Laennec分期多为F4c,肝实质细胞数量及功能显著下降,并呈现明显的肝内血管结构异常及血循环紊乱,肝脏易见炎症活动病变。肝细胞死亡引发大量炎细胞在肝脏内募集和Kupffer细胞过激活,刺激免疫介导的肝脏病理损伤,及炎症激活后引发的全身炎症反应综合征,是肝衰竭致多器官衰竭的主要病理生理机制。
- 肝功能衰竭 /
- 病理状态,体征和症状 /
- 活组织检查
Abstract: Liver failure is a group of hepatocyte dysfunctions caused by severe synthetic and metabolic disorders and has a high mortality rate. Histopathology has great clinical significance in the diagnosis, classification, and prognostic evaluation of liver failure. Extensive hepatocyte death and hepatocyte regeneration run through the whole clinicopathological process of liver failure, and necrosis is the major type of cell death in liver failure and is often accompanied by other types such as apoptosis, pyroptosis, and autophagy. Each type of liver failure has its own pathological features. Acute liver failure emphasizes consistent massive or submassive necrosis caused by one hit; subacute liver failure has the features of submassive or massive liver necrosis due to new and old lesions caused by multiple hits; acute-on-chronic live failure shows extensive hepatocyte necrosis caused by one or multiple hits on the basis of chronic liver disease; chronic liver failure has the histological features of liver cirrhosis with small nodules or mixed large-small nodules, compact and wide fibrous septa mainly composed of collagen type I, Laennec stage ( mainly F4 c) , significant reductions in the number and function of liver parenchymal cells, and marked intrahepatic vascular structural abnormalities and blood circulation disorders, as well as liver inflammatory lesions. Hepatocyte death triggers the recruitment of a large number of inflammatory cells and the overactivation of Kupffer cells and stimulates immune-mediated liver injury and systemic inflammatory response syndrome caused by inflammation activation, which are the main pathophysiological mechanisms of multiple organ failure caused by liver failure.
- liver failure /
- pathological conditions, signs and symptoms /
- biopsy

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