慢性乙型肝炎患者肝组织中CD8 CD28表达与肝窦病变的关系

Relationship between expression of intrahepatic CD8 and CD28 in patients with chronic hepatitis B and hepatic sinusoids' pathological changes

目的:探讨慢性乙型肝炎(CHB)肝组织中CD8,CD28在肝细胞中表达与肝窦病变的关系。方法:随机选择解放军第123医院肝病中心慢性乙型肝炎患者肝穿刺组织60例,穿刺肝组织采取免疫组化CD8,CD28双染色法,光镜观察其表达与肝窦病变的关系。结果:CD8,CD28阳性表达与肝窦狭窄、肝窦阻塞、肝窦扩张、肝窦毛细血管化密切相关。提示,肝窦病变较轻时以细胞毒性(杀伤性)T淋巴细胞CD8^+,CD28^+分子的表达占优势;调节性T淋巴细胞CD8^+,CD28^-分子少表达。随着肝组织炎症病变加重,炎症坏死区T淋巴细胞CD8^+,CD28^+分子的表达增强。而当肝组织肝窦毛细血管化较重,坏死修复并形成纤维间隔带或纤维瘢痕时则以抑制性(调节性)T淋巴细胞CD8^+,CD28^-分子表达为主。CD8,CD28分子在肝窦狭窄、阻塞、扩张、毛细血管化重度时表达均最高(P<0.01)。表明T淋巴细胞CD8,CD28分子的表达参与慢性乙型肝炎肝窦病变的病理转化。结论:慢性乙型肝炎肝组织中T淋巴细胞CD8,CD28分子的表达变化在肝窦病变的演变中担当一关键角色。

Objective：To observe the relationship between expression of intrahepatic CD8 and CD28 in patients with chronic hepatitis B（CHB） and hepatic sinusoids＇pathological changes. Methods：60 CHB patients admitted to our hospital were selected,who underwent liver biopsy with ultrasound guidance. Immunohistochemieal method was used to examine the expression of CD8 and CD28 in hepatic tissues. The relationship between expression of CD8 and CD28 and hepatic sinusoids＇pathological changes was observed and analyzed. Results：The expression of CD8 and CD28 was closely related to the contriction, emphraxis, dillation and sinusoidal capillarization in hepatic sinus. The results suggested that the expression of CD8^＋ , CD28^＋ T cells predominated over CD8^＋, CD28^ - T（ cytotoxic T lympocyte） at liver lesions＇early stage. The worse of the liver lesion was, the higher the expression of CD8 ^＋ , CD28^＋ T cells in liver inflammation necrotic area became. When liver sinusoidal eapillarization happened, necrosis repair, fibrous tissue septum and fibrous scar formation were mainly expressed as CD8^ ＋ , CD28^ - inhibitory regulatory T cells. Logistic regression analysis indicated that CD8^＋ , CD28^＋ T cells＇expression was highest when the contriction, emphraxis, dilation and sinusoidal capillarization in hepatic sinus was severe（ P 〈 0.01）. The above showed that the expression of CD8^＋ , CD28^ ＋ T cells took part in hepatic sinus lesions＇pathological changes. Conclusion： The expression of intrahepatie CD8 ^＋ , CD28 ^＋ T cells in patients with CHB played a key role in the pathological changes of hepatic sinusoids.