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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 5
Objective To investigate the clinicopathological characteristics and pathogenesis of autoimmune hepatitis (AIH). Methods The serum and punctured liver tissue of 26 patients with AIH before treatment were analyzed by serology, pathology and clinical observation, and were scored according to IAIHG (1999) standard. Various dendritic cells (DCs) The changes of DC in liver tissue were observed by immunohistochemistry. The activation and proliferation of hepatic stellate cells (HSC) and the expression of transforming growth factor β (TGFβ) were observed. Chronic hepatitis B and C Hepatic liver tissue of 10 cases, 5 cases of normal liver tissue as a control. Results Type Ⅰ and Type Ⅱ in 26 cases of AIH accounted for 80 8% (2 1 2 6) and 192% (526), respectively, and the cumulative scores were 18 6 ± 1 4 and 19 1 ± 2 1, respectively. There were significant differences in mean age, serum ALT, AST and γ Glo between Ⅰ and Ⅱ (P <0.01 or P <0.01 or P <0.05). Twenty six AIH liver tissues showed active chronic inflammatory changes, including 100% of interface necrosis (PN), 571% of type Ⅰ of BN, 80% of type Ⅱ (P <0.05) ), Significant lobular endometriosis type 952%, type Ⅱ 10 0%, type Ⅰ hepatosteatosis 71 4%, type Ⅱ 10 0% (P 0 01), central lobular area type 1 33 3%, Type Ⅱ 80 0% (P 0 01). Significant plasma cell infiltration was 95 2% in type Ⅰ and 200% in type Ⅱ (P 0 01). Positive DC diffuse or accumulate in the portal area and the hepatic lobule, especially in the AIH hepatic tissue active lesion area, type Ⅰ 85 7% (18 2 1), type Ⅱ 5