Comparative Study Of Budd-Chiari Syndrome And Intrahepatic Portal Hypertension With Pathological Changes In The Liver Tissue

ObjectiveComparative study of Budd-Chiari syndrome(B-CS) and Intrahepatic Portal hypertension (IPH) about the liver tissue pathology change, with the patients before and after surgery.MethodsFrom January2010to December2011, liver-biopsy was taken during shunt surgey (19B-CS patients,14IPH patients, before the surgery).6months after surgery,Collagen type IV (Col IV),Procollagen III (PC III)), Matrix metalloproteinase (MMP-1),Tissue inhibitors of metalloproteinase (TIMP-1) were tested using SABC (immuonohistochemistry) method. and HE staining to observe the morphological of liver tissue. Free portal vein pressure before and after shunt was measured. Test the variation range of the free portal pressure before and after shunt during the surgery, and analysis it with the degree of the liver fibrosis.ResultsIn B-CS group, Col IV, PC Ⅲ and TIPM-1expression were downregulated after surgery(t=4.896,p=0.013;t=4.877,p=0.003;t=2.841,p=0.023),MMP-1have no obvious correlation (P>0.05), while MMP-1/TIPM-1was not significantly correlated with liver fibrosis (t=-0.710,p=0.504). In IPH group, the expression of Col IV, PC III, TIPM-1and MMP-1/TIPM-1did not change significant after surgery(P>0.05). compared with that in IPH group the expression of ColIV, PCIII and TIPM-1downregulated significantly in B-CS group (U=3.000,p=0.038;U=2.000,p=0.023;U=3.000,p=0.038).By HE staining showed that, B-CS group experienced phonenomen-ons of congestion, mild silting hemorrhagic inflammatory changes, dark-red colored, cell swelling, loose cytoplasm, some ballooning degeneration, and slight fibrosis proliferation before surgery. Cell shape and lobular structure present obvious trend of reversible transformation to the normal structure; While for PHT group, color of the liver was gray yellow, and the liver experienced medium-severe silting hemorrhagic inflammatory change, the normal structure was damaged, and fiber grew extensively. No significant change was found after surgery, and reversibility was not obvious. FPP of B-CS and IPH were significantly decreased after shunt (t=17.816,p=0.000;t=5.745, p=0.010). Drop of FPP of B-CS group plays a key role in reversal of liver fibrosis.Conclusion1. The pathological lesions of B-CS is based on sinusoidal congestion, mild inflammatory changes mainly, while IPH is the performance of substantial liver fibrosis,its reversibility not significantly compared with the B-CS. 2. PCⅢ, ColⅣ and TIPM-1can reflect the liver fibrosis which has important implications for assessing liver fibrosis reversibility postoperatively.3. B-CS,early treatment to shunt decompessiom,reduce portal pressure and ease the congestion status can accelerate the improvement of liver function, and promote fibrosis reversal.