原发性胆汁性肝硬化的临床与肝脏病理相关性研究

Clinical and pathological features of primary biliary cirrhosis

目的 研究原发性胆汁性肝硬化（PBC）患者临床与肝脏病理变化的相关性。方法 24例初诊未经治疗的PBC患者的肝脏穿刺标本常规进行苏木素－伊红染色，记录病理分期、纤维化、汇管区炎症、汇管区周围碎屑坏死、肝细胞坏死性损害、胆管增生及胆管减少程度；分析前述指标的临床相关性。正态资料组间比较用χ^2或t检验，非正态资料及等级资料进行Mann-Whitmey U非参数检验，相关分析用Pearson和Spearman相关分析。结果病理分期、纤维化程度与总胆红素、直接胆红素（DBIL）、总胆汁酸、总胆固醇、IgG均呈正相关，与白蛋白、血嗜酸细胞（EOS）比例呈负相关（r=-0．527，P=0．030；r=-0．503，P=0．039和r=-0．554，P=0．021；r=-0．502，P=0．040）。汇管区周围碎屑坏死与碱性磷酸酶（ALP）、总胆红素、DBIL、总胆汁酸呈正相关，还与血肿瘤坏死因子（TNF）-α水平呈正相关[r=0．617，P=O．006]。结论 总胆红素、DBIL、总胆汁酸、总胆固醇、IgG与白蛋白、EOS比例反映了疾病严重程度和不可逆性，而ALP、TNF-α仅、总胆红素、DBIL、总胆汁酸反映疾病活动程度。

Objective The aim of this study was to describe the clinical and pathological features of primary biliary cirrhosis （PBC） and their correlation. Methods Liver biopsy specimens were obtained through percutaneous needle puncture from twenty four patients with PBC who had not been diagnosed or treated before. These samples were fixed in formaldehyde and embedded in paraffin for routine histological examination. Pathologic stages based on Ludwig criteria, fibrosis, portal and periportal inflammation, lymphocytic periportal piecemeal necrosis, ductular proliferation, intralobular hepatocyte necrosis, the degree of ductopenia and relevant laboratory results were recorded, Statistics method used was X^2 or t-test, Mann-whitmey U nonperametric test and Pearson＇s or Spearman＇s correlation analysis. Results The pathological stages, degree of fibrosis were positively correlated with total bilirubin （TBIL） level, total bile acid （TBA）, cholesterol （CHO）, IgG levels, and were negatively correlated with serum albumin（ALB） level（r=-0.527, P=0.030; r=-0.503, P=0.039） , percentage of eosinop hilic cells （EOS） （r=-0.554, P=0.021 ; r=-0.502, P=0.040）. Lymphocytic periportal piecemeal necrosis was positively correlated with alkaline phosp-hatase （ALP）, TBIL, DBIL, TBA, and also tumor necrosis factor-α （TNF-α） levels （r=0.617, P=0.006）. Conclusion TBIL, DBIL, TBA, CHO, IgG and ALB, EOS are good surrogate markers for disease sever ity and reversibility of PBC, while ALP, TNF-α, TBIL, DBIL, TBA can be used as markers for disease activity.