Study On Hepatic Fibrosis In Patients With Chronic Hepatitis B Complicated With Hepatic Alveolar Echinococcosis

Viral hepatitis,alcohol,drugs,parasitic infection and other factors can lead to liver fibrosis,serious cases can progress to cirrhosis,or even liver cancer.Some cases of mixed infection of hepatic alveolar hydatid(HAE)and chronic hepatitis B(CHB)have been found clinically.Among these mixed infection cases,there is no case of hepatic vesicular hydatidosis combined with liver cancer in our hospital,and it is also rarely reported in other medical institutions and literature.Both HAE and CHB diseases can lead to liver fibrosis,but there are few literatures describing and summarizing the characteristics of liver fibrosis in the cases of mixed infection of the two diseases.Hepatic fibrosis in patients with chronic hepatitis B complicated with hepatic alveolar hydatid disease(HAE&CHB)was studied by histological examination,shear wave elastography and hepatic fibrosis serological examination.To compare the difference of liver fibrosis between coinfection patients,chronic hepatitis B(CHB)patients and hepatic vesicular hydatid disease(HAE)patients.To increase the understanding of liver fibrosis caused by this type of HAE&CHB disease,and to provide a certain reference for clinical treatment and basic research.Methods:In this study,26 patients with chronic hepatitis B complicated with hepatic alveolar hydatidosis(HAE&CHB group),50 patients with hepatic alveolar hydatidosis(HAE group),and 20 patients with chronic hepatitis B(CHB group)who were hospitalized in the Affiliated Hospital of Qinghai University between May 2019 and December 2020 were collected.All the patients were from Qinghai,and all the HAE&CHB patients were Tibetan.Among the patients undergoing liver surgery,liver tissue 2cm away from the edge of the lesion>(about0.5cmx0.5cm)was collected,and the degree of liver fibrosis under microscope was analyzed by HE staining.In non-operative patients,the liver fibrosis was evaluated by shear wave elastography and hepatic fibrosis serologic examination.Statistical analysis was performed to evaluate liver fibrosis in the HAE&CHB group,and a control study was conducted with CHB group and HAE group.Results:(1)The infection rate of HBV in HAE infected patients was significantly higher than that of the general population.(2)Histopathological results of the liver showed that granulomatous hyperplastic changes were observed around hydatid lesions by HE staining.The liver tissue was segmented into strips,with annular fibrous tissue hyperplasia and infiltration of eosinophils,plasma cells,macrophages and lymphocytes.There is granulomatous inflammation around the vesicles,pseudoblobule formation,and the portal area is compressed and deformed.(3)The results of liver histology showed that by HE staining,HAE group patients without obstructive jaundice(OJ),the morphology of liver cells and the structure of liver lobules beyond 2cm of the edge of the lesion were basically normal,no obvious hepatic fibrosis was observed.Most of the hepatic fibrosis changes were of grade 0-I.In patients with HAE combination and OJ,fibrous tissue hyperplasia and pseudoblobule formation were observed in portal area 2cm away from the edge of the lesion.In patients in the HAE&CHB group without OJ,eosinophils and lymphocytes were observed in bile ducts in portal area,and a variety of inflammatory cell infiltration was observed in liver tissues 2cm away from hydatid lesions.Inflammatory manifestations were observed in bile ducts and boundary plates,with a small amount of fibrous tissue formation,and no obvious hepatic fibrosis.Patients with HAE and CHB combined with OJ had similar microscopic manifestations as patients with HAE combined with OJ.(4)According to the results of liver elastography,the elasticity value of HAE&CHB group was 5.17 k Pa ±1.22.The elastic value of CHB group was 8.17 k Pa±1.53.The elastic value of HAE group was 5.02 k Pa ±1.15.(5)The liver fibrosis grading beyond 2cm of the hydatid lesion margin showed that there was statistically significant difference in liver fibrosis grading between HAE&CHB group,HAE group and CHB group(P < 0.05).(6)Compared with CHB and HAE groups,the contents of type III procollagen peptide,type IV collagen and hyaluronic acid in serum of the four tests of serum liver fibrosis in the HAE&CHB group were higher than those in the HAE&CHB and HAE groups,with statistical significance(P < 0.05).Conclusion:1.HBV carrying rate was significantly higher in patients with HAE.2.In the HAE&CHB group,the nodular and massive hydatid lesions showed solid and sclerosing changes,while the cyst wall of the liquefaction necrotic vesicle lesions showed obvious fibrosis changes.In the HAE&CHB group,liver tissue beyond2 cm of lesion did not show more serious hepatic fibrosis damage.3.Patients with HAE&CHB combined with biliary tract invasion complicated with obstructive jaundice showed higher degree of liver fibrosis in liver tissue beyond 2cm.