原发性胆汁性肝硬化AMA-M_2阴性患者的临床及病理特点

Clinical and pathological features of primary biliary cirrhotic patients with negative anti-mitochondria antibody M_2 subtype

目的:探讨原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)中AMA-M2阴性患者的临床及病理特点.方法:2000-2007年昆明医学院第二附属医院PBC患者56例.分析AMA-M2阴性PBC患者临床资料及病理资料,并与AMA-M2阳性患者临床资料进行对比.结果:AMA-M2抗体阳性与阴性患者间一般资料及血清指标均无显著性差异(均P>0.05).22例AMA-M2阴性PBC患者胆管改变明显,以小胆管最具特征性,其表现与所处的分期有关,胆管周围见炎性细胞浸润,以淋巴细胞为主;汇管区细胞浸润现象明显,以淋巴细胞最为重要,甚至形成淋巴滤泡;肝细胞改变相对较轻,缺乏特异性;同一份标本可见不同时期的改变,各期改变可相互混杂.结论:病理组织学是确诊AMA-M2阴性患者的重要检查,同时是分期的重要标准.

AIM： To explore the clinical and pathological features of primary biliary cirrhotic （PBC） patients with negative antiitochondria antibody M2 subtype （AMA-M2）. METHODS： Fifty six PBC cases from the second affiliated hospital of Kunming Medical College between AD 2000 and 2007 were selected. The clinical data （general status, laboratory findings） and pathologic data were reviewed in 22 cases of negative AMA-M2 antibody. And the clinical data of the negative AMA-M2 anti-body cases were compared with the positive ones. RESULTS： The general status and laboratory findings （biochemical data, immune function） of AMA-M2 antibody negative were compared with the positive ones, with no significant difference observed （all P 〉 0.05）. Remarkable changes in bileducts, especially in small bile ducts were observed in 22 negative AMA-M2 antibody cases. Those changes were related to staging. Inflammatory cells, mainly lymphocytes were seen around the bile duct. Remarkable infiltrated inflammatory cells, mainly lymphocytes, even lymphoid follicles were observed in the portal area. Liver cells changed mildly and were non-specific. The changes of different stages existed and intermixed in one sample. CONCLUSION： Liver biopsy is useful to confirm to diagnosis of PBC with negative M2 antibody and an important criteria for staging determination.