低酶学水平的慢性HBV感染者肝组织学改变与CD_(28)表达的相关性研究

Correlation between liver histological changes and the expression of CD28in the patients with chronic HBV infection with low ALT.

目的研究低酶学水平(ALT≤3ulm)的慢性HBV感染者肝组织学改变及CD28的表达水平,探讨CD28与肝组织学变化及血清酶学(ALT)变化的相关性,为临床处理该类人群提供参考。方法①病例筛选:选取低酶学水平(ALT≤3ulm)、HBV-DNA定量≥103copies/ml的慢性乙肝病毒(HBV)感染病例71例行肝穿肝组织学检测;②肝组织病理检测:采用HE染色检测肝组织的炎症活动度和肝纤维化程度;③免疫组化:SP法检测肝组织中CD28的表达,在高倍镜下观察阳性细胞的表达,采用Image-ProPlus6.0彩色图像分析系统对图象进行分析。用积分光密度值(IOD值)表示其在肝组织中表达的强度。结果①病理学检查情况:71例患者中,肝组织学完全正常(G0S0)者3例(4.23%),肝组织学存在不同程度损害者68例(95.77%),其中早期肝硬化3例(4.23%)。②CD28表达:在所有检测的肝组织中均有表达,主要集中在胞浆中。在不同炎症活动度和纤维化程度的肝组织中,所测得阳性细胞的积分光密度值比较差异有统计学意义(P<0.05)。③ALT水平与CD28表达的关系:CD28表达在不同ALT分组间差异有统计学意义(P<0.05)。结论肝组织中CD28的表达与肝组织炎症活动及纤维化进程有密切联系。

Objective To study liver histology changes and expression of CD28 in patients with chronic HBV infection with low enzyme levels （ALT≤ 3 ulm）, and to explore the correlation between them, in order to provide reference for the clinical practice. Methods （1） Screening： Seventy-one patients with chronic HBV infection with low enzyme levels （ALT≤ 3 ulm） and HBV-DNA quantitative 1〉 10^3 copies/ml were selected for liver histological detection; （2） Pathological examination： The degree of inflammatory activity and hepatic fibrosis were detected by HE. （3） Immunohistochemistry： The expression of CD28 in hepatic tissue was detected by SP assay, High magnification was applied to observe the expression of positive cells. Image-Pro Plus 6 color image processing system was used for image analysis. Integrated optical density （IOD） was used to represent the intensity of expression in the liver tissue. Results （1） Patho- logical examination： Of the 71 patients, the liver was fully functional histologically （G0S0） in 3 cases （4.23%）, and the liver was found with different degrees of damage in 68 cases （95.77%）, including 3 cases （4.23%） of hepatocirrhosis. （2） CD28 expression： The expression of CD28 was detected in all the liver tissues tested, mainly concentrated in cytoplasm. In the liver tissues with different degree of inflammatory activity and fibrosis, the IOD showed statistically significant difference （P〈0.05）. （3） Correlation between ALT levels and CD28 expression： The expression of CD28 showed statistically significant difference between the different ALT groups （P〈0.05）. Conclusion The expression of CD28 in liver tissue is closely related to inflammatory activity and fibrosis.