The Study On Histological Changes, HSC, CD28 And HBcAg In The Chronic HBV Infection Of Low ALT

Objective:To study the histological changes, activation ofhepatic stellate cells (HSC), the expressions of CD28 and HBcAg in low ALT (≤3ULN) chronic HBV infection, exploreing the interaction with the related factors and provide evidence for clinical treatment. Methods:1. Cases screening:The 71 cases of chronic HBV infection with low ALT (≤3ULN) and HBV-DNA quantitative≥103copies/ml in serum were adminted in these study. All cases accepted liver biopsy guiding by B-mode ultrasonic.2. Pathological slice preparation:Liver tissues were stained with hematoxylin and eosin after paraffin embedding and cut sheeting, the inflammation and fibrosis degree were detected.3. Immunohistochemical method:HSC was marked by synaptic element (SYN). The SYN positive cells in liver tissue and the expressions of HBcAg and CD28 were measured by streptavidin-perosidase (SP) method.The positive expression means that tan or brown stain was found in five discontinuous visual fields under high magnification (400×).The results analyzed by Image Pro Plus 6.0. The expression intensity of these three in liver tissue was measured by Integral light density (IOD) titres. Results:1.Liver histopathological results:In the 71 cases, there were 3 cases (4.23%) that liver histopathological changes were complete normal (GOSO); The rest had varying degree damage in which 3 cases were early liver cirrhosis (4.23%),26 cases (36.62%) had inflammation active grade 1,28 cases(39.44%) grade 2,14 cases(19.72%) grade 3. and for the fibrosis stage, there were 23 cases (32.39%) in fibrosis stage 1,29 cases (40.85%) in stage 2,7 cases (9.86%) in stage 3,3 cases (4.23%) in stage 4,9 cases (12.68%) in stage 0.2. The expression of SYN positive cells:SYN positive cells of the liver tissue were expressed in 71 cases and distributed similarly in different inflammation active grade and fibrosis stage。There were significant difference that the expression of SYN positive cells in different inflammation active grade and fibrosis degree of liver tissue(P<0.05).3. The expression of CD28:CD28 of the liver tissue were expressed in 71 cases, mainly lied in the cytoplasm, stained deeply in inflammatory necrotic area and around fibrosis. There were significant difference expression of CD28 in different inflammation active grade and fibrosis degree of liver tissue (P<0.05.4. The expression of HBcAg:71 cases of liver tissue expressed HBcAg, mainly in hepatic nucleus and cytoplasm, and there was no significant difference in the expression of HBcAg in liver tissues among the groups with different inflammatory activity or fibrosis degrees (P>0.05).5. Correlation of SYN, HBcAg and CD28:Neither the expression of HBcAg and CD28 nor HBcAg and SYN in the liver tissue had linear trend (r= 0.2> 0.05), but the linear trend had been found between CD28 and SYN (r= 0.2, P< 0.05).6. The relationship between ALT level and the expressions of SYN, HBcAg, and CD28:The expressions of SYN and CD28 were related with the level of ALT. There were significant difference between the expressions of SYN or CD28 and the ALT level (P<0.05. The expressions of HBcAg were not related with the level of ALT. (P>0.05.7. Relationship between ALT level and histological changes:The inflammation active grade was related with the level of ALT (P< 0.05) while the fibrotic stage was not related with the level of ALT. (P> 0.05). Conclusion:1. The activation of HSC may have a positive correlation with inflammation of the liver tissue and fibrosis; 2. CD28 play a role in the process of liver tissue inflammation and fibrosis 3. There may existed some relationship between HSC activation and the expression of CD28 in liver tissue; 4. ALT can not completely reflect the degree of the liver tissue pathology damage. Patients with ALT mild abnormal still need to pathologic biopsy, thus more accurate judgement of the illness can be made.