胆道闭锁自体肝生存时间与胆管反应的关系研究

Relationship between native liver survival and ductular reaction in biliary atresia

目的探讨胆道闭锁自体肝生存时间与Kasai手术时肝活检胆管反应相关指标间的关系。方法选取天津市儿童医院行Kasai手术后自体肝生存时间超过5年,且无严重并发症的BA患儿10例作为预后良好组(BA-A组),同期行Kasai手术后1年内死亡或行肝移植的BA患儿10例作为预后不良组(BA-B组);另选取胆总管囊肿患儿10例(CC组),胆汁淤积症患儿10例(CS组),尸检病例5例(尸检组)作为本研究的对照组。应用HE及免疫组织化学染色方法,对4组患儿肝组织病理学指标(肝纤维化程度、胆管增生、胆栓、汇管区炎症细胞浸润程度)进行评分,并检测CK7、CK19、CD56、Ep CAM抗体表达情况,计算四种蛋白的平均光密度值(AOD),分析BA自体肝生存时间与肝组织胆管反应的关系。结果 BA组肝组织肝纤维化程度、胆管增生、胆栓评分均高于3组对照组,差异有统计学意义(H=24. 208,P <0. 05; H=39. 779,P <0. 05; H=23. 119,P <0. 05); CK7、CK19、CD56、Ep CAM四种蛋白在BA组的表达量明显高于3组对照组,差异有统计学意义(F=111. 184,P <0. 05; F=1064. 972,P <0. 05; F=79. 054,P <0. 05; F=53. 858,P <0. 05); BA预后良好组CK7、CD56、Ep CAM表达量低于预后不良组,差异有统计学意义(t=12. 686,P <0. 05; t=9. 517,P <0. 05; t=5. 232,P <0. 05)。结论肝组织病理学评分可用于BA与其他梗阻性黄疸的鉴别诊断; Kasai手术时肝活检胆管反应与自体肝生存关系密切,CK7、CD56及Ep CAM蛋白可以作为BA预后的相关指标,其表达量越少,自体肝生存时间越长。

Objective To explore the relationship between ductular reaction in liver biopsy during Kasaiand native liver survival of biliary atresia （BA）. Methods The cases of BA were selected for time of nativeliver survival over 5 years after Kasai and nonsevere enough for diagnosing （BAA,n = 10） and time of nativeliver survival under 1 year after Kasai （BAB,n = 10）,choledochal cyst （CC,n = 10）,cholestasis （CS,n =10） and autopsy （ n = 10）. HE and CK7,CK19,CD56,EpCAM immunohistochemical staining methods wereemployed for scoring the pathological indices of four groups and calculating the AOD of four proteins. And therelationship was analyzed between native liver survival and ductular reaction in BA. Results The degrees ofhepatic fibrosis,bile duct hyperplasia and bile embolus score in BA group were higher than those in three control groups and the differences were statistically significant（H = 24. 208,P 〈 0. 05; H = 39. 779,P 〈 0. 05; H =23. 119,P 〈 0. 05）;They are significant differences expression of CK7,CK19,CD56 and EpCAM in liver tissues of BA,CC,CS and control group and the expression of BA group was significantly greater than controlgroups （F = 111. 184,P 〈 0. 05;F = 1064. 972,P 〈 0. 05;F = 79. 054,P 〈 0. 05;F = 53. 858,P 〈 0. 05）. Theexpressions of CK7,CD56 and EpCAM in good prognosis group of BA were significantly lower than those of poorprognosis group （t = 12. 686,P 〈 0. 05;t = 9. 517,P 〈 0. 05;t = 5. 232,P 〈 0. 05）. Conclusion Liver histopathology scores may be used in the differential diagnosis of BA and other obstructive jaundice. Ductular reaction in liver biopsy during Kasai is closely correlated with native liver survival of BA. And CK7,CD56 and EpCAM proteins may be used as prognostic indicators of BA. The lower expressions,the longer survival time of autologous liver.