The Digital Pathological Features Of Chronic Hepatitis B And The Effect Of TCM Syndrome On Prognosis Based On Curative Effect Analysis

Aims:Establish a reliable digital pathological quantitative analysis method for vessels and bile ducts in liver biospies.By comparing the digital pathological features of chronic liver diseases with different etiology,the changes of collagen and tubes in the process of liver fibrosis were analyzed,and the changes of vascular and bile duct characteristics in the process of chronic hepatitis B were elucidated.And through the analysis the digital pathological features between the reversal and the unreversed population of chronic hepatitis B,to elucidate the role of changes of vascular and bile ducts in the reversing process of liver fibrosis.Analyzing the differences in digital pathological features between different syndromes of TCM,to clarify The scientific significance of Chinese medicine on the classification of chronic hepatitis B and the influences of its prognosis.Methods:Part Ⅰ: Digital characteristic pathological patterns of chronic hepatitis B: 46 patients with chronic hepatitis B,49 patients with primary biliary cholangitis,21 patients with nonalcoholic fatty liver disease,and 15 patients with normal liver were included.All liver biopsies were in different fibrosis stages evaluated by METAVIR system.All slides were scanned with Genesis,then immunohistochemically stained with CD34,CK19,α-SMA to identify veins,bile ducts and arteries respectively,the staining results were used as a reference for developing the qVessel algorithm.The characteristic collagen and luminal changes patterns of chronic hepatitis B were described by comparing the digital pathological features of chronic liver diseases with different causes in each fibrosis stage.Part Ⅱ: The reversal digital pathological features of chronic hepatitis B: 180 patients with chronic hepatitis B were included.All samples were quantified by q Fibrosis and qVessel.Analyzing the digital pathological features between the reversal and the unreversed population of chronic hepatitis B,to elucidate different digital pathological features in reversal population and its significance for the prognosis of the disease.Part Ⅲ: Digital pathological features of TCM syndromes: 157 patients with chronic hepatitis B were included.All samples were quantified by q Fibrosis and qVessel.Analyzing the digital pathological features of different syndromes of TCM to clarify The scientific significance of Chinese medicine on the classification of chronic hepatitis B and the influences of its prognosis.Results:1.qVessel can distinguish the luminal properties of arteries,veins,and bile ducts by elastic fibers and perivascular collagen types.In patients with chronic hepatitis B,with the increasing of fibrosis,the parameters of total amount of collagen and the change of total morphology are increasing(P<0.05),parameters of amount of collagen and the change of morphology are increasing in the portal area and sinusoidal area(P<0.05),parameters of amount of collagen and the change of morphology are no significant changes in central veins area(P>0.05).There was no significant change in parameters of number and morphology of central veins,portal veins,and bile ducts(P>0.05),parameters of number and morphological of arteries are increasing(P<0.05).In patients with primary biliary cholangitis,with the increasing of fibrosis,the parameters of total amount of collagen and the change of total morphology are increasing(P<0.05),parameters of amount of collagen and the change of morphology are increasing in the portal area and sinusoidal area(P<0.05),parameters of amount of collagen and the change of morphology are no significant changes in central veins area(P>0.05).There was no significant change in parameters of number and morphology of central veins,portal veins(P>0.05),parameters of number and morphological of arteries and bile ducts are increasing(P<0.05).In patients with nonalcoholic fatty liver disease,with the increasing of fibrosis,the parameters of total amount of collagen and the change of total morphology are increasing(P<0.05),parameters of amount of collagen and the change of morphology are increasing in the portal area(P<0.05),parameters of amount of collagen and the change of morphology are no significant changes in central veins area and sinusoidal area(P>0.05).There was no significant change in parameters of number and morphology of central veins,portal veins,bile ducts and arteries(P>0.05).2.After the treatment,the total amount of collagen decreased(P<0.05)and the parameters of collagen in the sinusoid area increased in the reversal group(P<0.05).And in the unreversed group,the total amount of collagen increased,the parameters of collagen in each segment,parameters of portal veins,and parameters of arteries were increased,but there is no significant changes(P>0.05).3.There were big differences in the parameters of central venous and the parameters of arteries between the reversal group and the unreversed group in the liver and gallbladder dampness syndrome(P<0.05).There were big differences in the parameters of central venous and the parameters of portal veins between the reversal group and the unreversed group in liver stagnation and spleen deficiency syndrome(P<0.05).In the liver and kidney yin deficiency syndrome,there was little differences in the digital pathological features of tubes between the reversal population and the unreversed population(P>0.05).Conclusions1.qVessel can be a useful tool to analyze vessels in liver biopsies.The progression of fibrosis is mainly manifested in the accumulation of collagen in patients with primary biliary cholangitis and nonalcoholic fatty liver disease,and in morphological changes in patients with chronic hepatitis B.In patients with primary biliary cholangitis or nonalcoholic fatty liver disease,the number of portal veins and the reduction of tube area are more likely to occur than in patients with chronic hepatitis B.The increasing number of arteries and tube area in patients with chronic hepatitis B is occurred earlier than in patients with other two diseases.2.In CHB patients,digital pathology suggests that the reversing of liver fibrosis may be accompanied by remodeling of extracellular matrix of hepatocytes and remodeling of portal veins and arteries.At the same time,the population with lower central venous parameters before treatment is more likely to be reversed after treatment.3.The three syndromes may exhibit different characteristics in the digital pathology of tubes,and the anti-fibrotic treatment may have different effects due to the types of syndromes.