摘要
目的 探讨自身免疫性肝炎 (AIH)的临床病理特征及发病机理。方法 对 2 6例治疗前AIH患者的血清和穿刺肝组织进行血清学、病理学及临床观察分析 ,并采用IAIHG(1999年 )标准进行评分 ;采用多种树突状细胞 (DC)标志性抗体 ,以免疫组化方法对肝组织中DC的变化进行观察 ,并对肝星状细胞 (HSC)的活化与增殖 ,及转化生长因子 β(TGF β)的表达作观测 ,另取慢性乙、丙型肝炎肝组织各 10例 ,正常肝组织 5例作对照。结果 2 6例AIH中Ⅰ型和Ⅱ型分别占 80 8% (2 1 2 6 )和19 2 % (5 2 6 ) ,累计评分均值分别为 18 6± 1 4和 19 1± 2 1。Ⅰ和Ⅱ型比较 ,平均年龄、血清平均ALT、AST及γ Glo差异有显著性 (P <0 0 0 1或P <0 0 1或P <0 0 5 )。 2 6例AIH肝组织均呈活动性慢性炎症改变 ,其中界面炎 碎屑坏死 (PN) 10 0 % ,桥接坏死 (BN)Ⅰ型 5 7 1% ,Ⅱ型 80 0 % (P <0 0 5 ) ,显著性小叶内炎Ⅰ型 95 2 % ,Ⅱ型 10 0 % ,玫瑰形肝细胞Ⅰ型 71 4% ,Ⅱ型 10 0 % (P <0 0 1) ,小叶中央区融合性坏死Ⅰ型 33 3% ,Ⅱ型 80 0 % (P <0 0 0 1) ,明显的浆细胞浸润Ⅰ型 95 2 % ,Ⅱ型 2 0 0 % (P <0 0 0 1)。阳性DC弥散或聚集分布于汇管区及肝小叶内 ,尤其在AIH肝组织活动性病变区 ,Ⅰ型85 7% (18 2 1) ,Ⅱ型
Objective To explore the clinical and pathological characteristics and pathogenesis of autoimmunohepatitis (AIH).Methods The serum and liver biopsy specimens and clinical data of 26 cases with patients with AIH were analyzed and scored according to the criteria of International autoimmune hepatitis (IAIHG,1999).The changes of dendritic cells (DC) in the liver tissues were observed with a panel of DC markers (CD-80/B7-1,CD-86/B7-2,CD-1a and HLA-DR) and immunohistochemistry,and the activation of hepatic stellate cells (HSC) and the expression of TGF-β were also detected.Liver tissue specimens from 10 patients with chronic viral hepatitis B and C respectively and 5 normal liver specimens were chosen as controls.Results Mean aggregate scores of 26 AIH cases,including 21 cases of typeⅠ(80.8%) and 5 cases of type Ⅱ(19.2%),which were 18.6±1.4 and 19.1±2.1 respectively.There were significant differences between the type Ⅰ and type Ⅱ in the average age.levels of serum ALT and AST,and γ-Glo (P<0.001 or P<0.01 or P<0.05).Histological features of all the AIH liver tissues showed the lesions of chronic active hepatitis such as interface hepatitis/piecemeal necrosis(100%),obvious lobular inflammation (type Ⅰ95.2%,type Ⅱ100%),bridging necrosis (57.1% type Ⅰ,80.0% type Ⅱ,P<0.05),rosetting of liver cells (71.4% type Ⅰ,100% type Ⅱ,P<0.01),central lobular confluent necrosis (33.3% type Ⅰ,80.0% type Ⅱ,P<0.001),predominant plasmacytic infiltration (type Ⅰ95^2%,type Ⅱ 20.0%,P<0.001).The rates of increased and concentrated DC in the portal and lobular areas,especially in the active lesions in type Ⅰ and type Ⅱ AIH were 85.7%(18/21) and 5/5 respectively.It was found that DC and lymphocytes surrounded the hepatocytes which partly expressed HLA-DR antigen,while there were no or a few HLA-DR positive hepatocytes in controls.Meanwhile,the number of α-SMA positive HSC and the expression of TGF-β were obviously increased in AIH liver tissues.Conclusion Several clinical and pathological features of AIH were indentified in this study.As an antigen-presenting cell,DC might play an important role in the pathogenesis of AIH.In China,sub-type Ⅰ of AIH might be more frequent than sub-type Ⅱ and there were differences in clinical aspects,serology and pathology between the two types.
出处
《中华实验和临床病毒学杂志》
CAS
CSCD
北大核心
2002年第1期27-30,共4页
Chinese Journal of Experimental and Clinical Virology
关键词
自身免疫性肝炎
病理学
血清学
Hepatitis,autoimunity
Liver/pathology
Liver/serology
