自身免疫性肝病的临床与病理学特点分析

Clinical and pathological characteristics of autoimmune liver disease.

目的分析自身免疫性肝病的临床及病理学特点,探讨自身免疫性肝病早期诊断方法。方法采用国际自身免疫性肝炎小组新修订的描述性诊断标准和计分系统,对确诊的25例自身免疫性肝病患者肝穿刺标本采用HE染色、嗜银染色,结合标志性CD138抗体免疫组织化学染色观察肝组织内CD138阳性细胞数量、比例和分布状况,分析其病理学特点。结果25例患者中单纯AIH 9例(36%),单纯PBC 13例(52%),AIH-PBC重叠综合征3例(12%);其中女性19例,以中老年为主;肝功能改变以血清碱性磷酸酶(ALP)和γ-谷氨酰转肽酶(γ-GT)升高为主;肝活检病理学检查显示以慢性肝炎为特点,淋巴细胞、浆细胞及单核细胞浸润明显;CD138免疫组化染色示自身免疫性肝病组浆细胞数目明显多于慢性乙型病毒性肝炎组,分别为(7.1±5.2)个/HP和(3.3±2.0)/HP(P<0.05)。结论浆细胞数目增多对自身免疫性肝病的病理学诊断有一定的参考意义。

Objective To analyze the clinical and histopathological characteristics of autoimmune liver disease （ALD）, and to explore the diagnostic criteria. Methods By using descriptive diagnosis standard and scoring system which was newly revised by the International Autoimmune Hepatitis Group Report, 25 cases of autoimmune liver disease were chosen to analyze the histopathological feature and to observe the number, ratio and distribution of CD138 positive cells by means of argyrophil reaction （ by Grimeliu＇s ）, Hematoxylin - Eosin （ HE ） staining and immunohistochemical staining. Results There were 9 cases （36%） of pure AIH patients and 13cases（ 52% ） of pure PBC patients among the cases, the rest 3cases （12%） were over- lapped synthesis. The female patients with autoimmune hepatopathy was 19 cases, ALD mainly affects middle and old aged female patients; The levels of serum alkaline phosphatase （ALP） and serum gamma glutamy transpeptidase （r - GT） were very high; The main histopathological change was characterized of chronic hepatitis, the infiltration of lymphocytes, mononuclear cells and plasma cells in the portal tract or periportal area were found in the liver biopsie; The number of plasma cells in the ALD group were significantly higher than that in the CHB group [ （ 7. 1 ± 5.2 ） ]/HP and （3. 3 ± 2. 0）/HP, P 〈 0. 05 ]. Conclusion The increase of plasma cells in liver biopsy is possibly significant for diagnosis of ALD.