胆道闭锁患儿肝纤维化及炎症细胞浸润与Kasai术后胆管炎的关系

The correlation between liver fibrosis inflammatory infiltration and postoperative cholangitis after Kasai operation for children with biliary atresia

目的分析胆道闭锁(BA)患儿肝纤维化程度、炎症细胞浸润程度与Kasai术后胆管炎的关系。方法选取2015年1月—2016年12月在我院确诊为BA患儿92例,依照日本Ohkuma’s肝纤维化分级标准进行分组,分为肝纤维化Ⅰ级(8例)、Ⅱ级(31例)、Ⅲ级(35例)、Ⅳ级(18例)组。结合Kasai手术时日龄,分析肝纤维化与手术时日龄的关系。术中获取的肝组织标本采用苏木素/伊红(HE)、马松(Masson)染色评价其纤维化程度,免疫组化(IHC)染色检测白细胞共同抗原(LCA)、T淋巴细胞表面抗原(CD4、CD8)、巨噬细胞特异性抗体(CD68)等炎症细胞特异性标志抗体表达情况。结合Kasai术后随访资料,分析BA患儿肝组织炎症细胞浸润程度、肝纤维化程度与Kasai术后胆管炎的关系。结果 BA患儿手术时日龄越大,肝纤维化程度越重;常规病理染色结果显示肝组织以淋巴细胞浸润为主,Ⅰ级、Ⅳ级组LCA、CD4表达水平高于Ⅱ、Ⅲ级组,各组间CD68表达差异无统计学意义。92例BA患儿均获得随访,50例曾发生胆管炎,38例发生早期胆管炎,23例频发胆管炎;不同肝纤维化分级BA患儿Kasai术后胆管炎、早期胆管炎和频发胆管炎的发生率差异有统计学意义(P<0.05),Ⅰ级、Ⅳ级组胆管炎发生率高于Ⅱ级、Ⅲ级组。结论 BA患儿Kasai术后胆管炎的发生与肝纤维化程度和肝组织炎症细胞,尤其T淋巴细胞亚群的浸润有关。

Objective To analyze the relationship between the degree of hepatic fibrosis,the inflammatory cell infiltration and the postoperative cholangitis after Kasai operation in children with biliary atresia(BA).Methods A total of 92 children diagnosed as BA in our hospital from January 2015 to December 2016 were selected in this study.Patients were divided into hepatic fibrosis gradeⅠgroup(n=8),hepatic fibrosis gradeⅡgroup(n=31),hepatic fibrosis gradeⅢgroup(n=35)and hepatic fibrosis gradeⅣgroup(n=18),according to Japan’s Ohkuma’s hepatic fibrosis grading criteria.Combined with Kasai age,the relationship between hepatic fibrosis and surgical age was analyzed.Samples of liver tissues were evaluated by hematoxylin/eosin(HE)and Masson staining.The expressions of specific inflammatory cell marker antibody LCA,CD4,CD8 and CD68 in liver were observed by IHC staining.Combined with the postoperative follow-up data of Kasai,the relationship between the degree of inflammatory infiltration of liver tissue,the degree of hepatic fibrosis and the postoperative cholangitis of Kasai in BA children was analyzed.Results Routine pathological staining showed that lymphocytes infiltrated mainly in liver tissue.The expression levels of LCA and CD4 were higher in groupⅠand groupⅣcompared with those of groupⅡand groupⅢ.There was no significant difference in the CD8 expression between four groups.All 92 children with BA were followed up.It was found that cholangitis occurred in 50 cases,early cholangitis occurred in 38 cases,and frequent cholangitis occurred in 23 cases.The incidence of cholangitis,early cholangitis,and frequent cholangitis after Kasai surgery was statistically significant in BA patients with different grades of hepatic fibrosis(P<0.05).The incidence of cholangitis was higher in the groupⅠand groupⅣthan that in groupⅡand groupⅢ.Conclusion The occurrence of cholangitis after Kasai operation in children with BA is correlated with the hepatic fibrosis and liver inflammatory cells,especially T lymphocyte subgroups.