穿入现象在自身免疫性肝炎中的临床意义

Clinical significance of emperipolesis in autoimmune hepatitis

目的研究自身免疫性肝炎(Autoimmnue hepatitis,AIH)中发生穿入现象的概况以及其临床意义。方法H&.E染色后在显微镜下观察,AIH患者肝组织是否存在细胞穿入现象;通过Ishak评分系统对每一例AIH患者肝内炎症及纤维化评分,并对每例患者行界面性肝炎、浆细胞浸润以及玫瑰花结等情况的评估;随后,通过统计学分析AIH患者肝组织中发生穿入现象的比例,并分析穿入现象与肝内炎症及纤维化的关系以及与AIH特征性病理表现之间的关系。结果57.3%AIH患者肝组织中发现穿入现象,穿入现象发生后宿主肝细胞嗜伊红染色;随着AIH患者肝内炎症及纤维化的加重,穿入现象的发生比例逐渐增高,差异有统计学意义;发生穿入现象的AIH患者肝内界面性肝炎较无穿入组明显加重,同样在发生穿入组患者肝内玫瑰花结的发生率增加,而与浆细胞浸润无明显相关性。结论穿入现象可能是诊断AIH的重要病理学特征,并可能是AIH患者肝细胞损伤的机制。

Objective To investigate the incidence and clinic significance of emperipolesis in autoimmune hepatitis （AIH） patients in China. Methods A histological evaluation by hematoxylin-eosin staining in all AIH patients was performed. Assessment of Ishak score was carried out for intrahepatic inflammation or fibrosis, as well as evaluation of interface hepatitis, plasma cell infiltration and rosette formation in the liver. Then the incidence of emperipolesis was analyzed statistically in patients with AIH. Furthermore, the relation of emperipolesis with intrahepatic inflammation or fibrosis and other pathological characteristics of AIH were analyzed. Results The presence of emperipolesis was observed in 57. 3% AIH cases which was with hepatocyte eosinophilic stained. The incidence of emperipolesis showed positive correlations with the aggravation of intrahepatic inflammation or fibrosis. Histologically, patients with emperipolesis had higher incidences of interface hepatitis and rosette formation as compared with patients without emperipolesis. Conclusion Emperipolesis might be an important pathological hallmark for AIH which might even illustrate a novel mechanism of hepatocyte damage in AIH.