山梨医科大学雑誌　第8巻4号　155-162(1994)

＜原著＞ウイルス肝炎，肝硬変と肝細胞癌
―山梨医科大学症例の検討―

三俣昌子，吉田洋二

抄　録：1983年10月10日から1993年6月1日の期間に山梨医科大学附属病院検査部病理にて組織診断のなされた急性ウイルス肝炎87例，慢性ウイルス肝炎267例，肝硬変166例，肝細胞癌254例の年齢および性分布，ウイルス型を検討した。肝細胞癌症例については腫瘍の大きさ，分化度，肝硬変の合併率を調べた。年齢分布のピークは急性肝炎，慢性肝炎，肝硬変，肝細胞癌の順に10〜20歳の間隔で高齢化し，肝細胞癌の89%は50〜70代に集中した。男女比は前三者が2:1，後者が3 :1であった。ウイルス型は急性肝炎ではA，B型がほほ同数で多く，C型が肝硬変では50〜60%，慢性肝炎・肝細胞癌では約80%を占めていた。慢性肝炎・肝硬変ではB型は40歳以下に，C型は40歳以上に多く見られた。腫瘍の大きさは最大径が2.1〜5.0cmのものが43%を占め，分化度は高分化型が59%，低分化型は20%であった。また，肝細胞癌の65%が肝硬変を合併した。何れの疾患でもウイルス型による組織像の顕著な違いは見られなかったが，C型慢性肝炎は弱い炎症が改善されずに持続する傾向がみられた。またB型，C型いずれの慢性肝炎においても，肝実質内にはBリンパ球よりもTリンパ球をより多く認めた。

キーワード　肝炎，肝硬変，肝細胞癌，山梨



Viral Hepatitis, Cirrhosis and Hepatocellular Carcinoma in Yamanashi Medical University

Masako Mitsumata and Yoji Yoshida

Patients with viral hapatitis, including acute (87 cases) or chronic (267 cases) hepatitis, liver cirrhosis (166 cases) and hepatocellular carcinoma (254 cases), who visited Yamanashi Medical University Hospital between Oct 10, 1983 and June 1, 1993, were analyzed for age and gender distribution and viral type. Tumors were evaluated by size and cellular differentiation and the incidence of complication by liver cirrhosis was determined. All cases were diagnosed by histological examination. The peak age among patients with acute hepatitis, chronic hepatitis, liver cirrhosis and carcinoma shifted toward older patients in this order at 10-20 year intervals and 89% cases of carcinoma occurred in the 4th-6th decade. Male to female ratios were 2:1 in the former three diseases and 3:1 for carcinoma. Equal numbers of patients with acute hepatitis were infected by hepatitis virus A and B, while type C virus infection occurred in less than 20%. Type C virus infection was detected in 50-60% of cases of liver cirrhosis and 80% of cases of chronic hepatitis or carcinoma. Forty-three percent of tumor nodules were between 2.1 and 5.0 cm in diameter, 59% showed well differentiated carcinoma while 20% showed poorly differentiated type and 65% of carcinoma was accompanied by cirrhosis. There was no obvious quantitative histological difference between virus types, but T-lymphocytes in the liver parenchyma were observed more frequently than B-lymphocytes though both types of cells infiltrated the portal spaces in various amounts in chronic hepatitis due to either B or C virus.

Key words: Viral hepatitis, Cirrhosis, Hepatocellular carcinoma, Yamanashi



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