급성 virus성 간염에 있어서의 중심정맥반응

Abstract

Hepatic needle biopsy specimens from fifty two cases of acute viral hepatitis were analyzed and the central vein reaction of the hepatic tissue was investigated along with its histologic characteristics, prevalence and its diagnostic value. Of the fifty-two acute viral hepatitis specimens, 4:'1 (82.7%) accompained a variety of reactions to the central veins. Those alterations were able to be categorized largely into two forms; a phlebitic change and a smudging effect. The former represented the combined phenomena featuring simply from focal or diffuse circumferencial necrosis of the wall, neutrophilic exudation, segmental disrupdisruption of the limiting plates, to fibrinoid necrosis, with or without thrombosis and collapse: the latter smudging effect, on the other hand, was charac.. terized by edema and loss of fibrillar architectures. faint stainability and wrinking but without disruption of centrilobular limiting plates. The prevalence of the phlebitic changes in icteric type was 72.2% in acme phase, and 53% in subsi.. ding period; but those lesions remained in all cases of persisting phase and anicteric type, whereas in cholestatic and fulminant ones the changes were only found in one quarter and two-fifths, respectively. The smudging effect, a residual phenomenon, was identified in 14.3% of acme phase and 23.5% of subsiding period of icteric type. But this type of smudging was found rarely in cholestatic and, fulminant types. The above vascular alterations showed a tendency to subside with clinical recovery but became intensified in cases undergoing persis..· ting course or even in chronic aggressive hepatitis. The exact mechanism of these central vein reaction in acute viral hepatitis is not clearly postulated", but seemed to be the cumulative results of reflecting: the initial hepatic cell fall-out adjacent to the centr'ilobular limiting plates with subsequent inflammatory' exudative satellitosis and other degenerative changesextending to the limiting plates and eventual development of disruption and necrosis of vascular wall; as a feature of convalescence most of vasculitic: process appeared to undergo a smudging effect. which is foIl owed by a healing process completely returning to normal structures. Demonstration of the central vein reaction was helpful for the differential diagnosis from other hepatic disorders resem.. bling acute viral hepatitis morphologically, Relationship of phlebitis to the presence of HBsAg is not clearly understood because of the limited mate.. rials in this investigation, but further study with, more accurate informations on hepatitis B surface or core antigen and antibody positivity should be' foIlowed.