CAJ | 학술논문

目的探讨转氨酶升高的特发性炎性肌病(Idiopathic Inflammatory Myopathy, IIM)患者肝脏损伤情况及血清ALT来源;观察IIM患者与自身免疫性肝炎(autoimmune hepatitis, AIH)患者肝组织中CD138+浆细胞浸润情况.方法分析28例IIM患者临床及血清学资料,并对其中6例IIM患者及另外11例AIH患者行肝活检(HE常规染色和免疫组化特异性染色).结果 IIM患者血清ALT均值(198.8±209.0)U/L,50%(14/28)的患者血清ALT轻度升高,在(40~120)U/L之间,与AIH患者无明显差异(P>0.05),与健康人有显著性差异(P<0.01);乳酸脱氢酶(LDH)和羟丁酸脱氢酶(HBDH)异常率为100%和85.7%,显著高于肌酸激酶(CK)的78.6%;组织学检查:IIM患者肝组织损伤轻微,肝窦内和汇管区有少至中量炎症细胞浸润,未发现明显CD138+浆细胞浸润;而AIH患者肝组织损伤较重,汇管区有大量炎症细胞浸润并向周围肝实质扩散,汇管区有明显CD138+浆细胞浸润.结论转氨酶升高的IIM患者肝组织损伤轻微,血清ALT升高除来源于损伤肝组织外,还由肌肉等组织损伤共同引起,体液免疫在IIM相关肝损伤机制中可能未起重要作用.
목적 탐토전안매승고적특발성염성기병(Idiopathic Inflammatory Myopathy, IIM)환자간장손상정황급혈청ALT래원;관찰IIM환자여자신면역성간염(autoimmune hepatitis, AIH)환자간조직중CD138+장세포침윤정황.방법 분석28례IIM환자림상급혈청학자료,병대기중6례IIM환자급령외11례AIH환자행간활검(HE상규염색화면역조화특이성염색).결과 IIM환자혈청ALT균치(198.8±209.0)U/L,50%(14/28)적환자혈청ALT경도승고,재(40~120)U/L지간,여AIH환자무명현차이(P>0.05),여건강인유현저성차이(P<0.01);유산탈경매(LDH)화간정산탈경매(HBDH)이상솔위100%화85.7%,현저고우기산격매(CK)적78.6%;조직학검사:IIM환자간조직손상경미,간두내화회관구유소지중량염증세포침윤,미발현명현CD138+장세포침윤;이AIH환자간조직손상교중,회관구유대량염증세포침윤병향주위간실질확산,회관구유명현CD138+장세포침윤.결론 전안매승고적IIM환자간조직손상경미,혈청ALT승고제래원우손상간조직외,환유기육등조직손상공동인기,체액면역재IIM상관간손상궤제중가능미기중요작용.
Objective To investigate liver damage and the source of serum ALT in Idiopathic Inflammatory Myopathy(IIM) patients with hyperaminotransferase and observe the infiltrating CD138 positive plasma cells in liver tissue of IIM and autoimmune hepatitis patients. Methods Clinical and serologic data of 28 IIM patients was analyzed. The liver biopsy was carried out in 6 IIM patients and 11 AIH patients by HE staining and immunohistochemistry.Results The mean of serum ALT level is 198.8±209.0U/L in IIM patients and ALT elevated gently between 40~120U/L in 50%(14/28). Compare with AIH patients, there was no significant difference (P>0.05), Inversely, compare with the healthy controls,notable diference was be founding (P<0.01), The abnormal rate of Lactate Dehydrogenase (LDH) and Hydroxybutyrate Dehydrogenase (HBDH) are 100% and 85.7%, higher than 78.6% of the Creatinkinase (CK), Should that, liver damage was mild and a few to middle quantity inflammatory cells infiltrated in portal tract In the PM patients, in which no obviousCD138 positive plasma cells were found In AIH patients, liver damage was appreciably heavily, massive inflammatory cells infiltrated in portal tract and further extend to the surrounding liver parenchyma, and manifest infiltration of CD138 positive plasma cells were detected in portal tract.Conclusion Conclusion Slight liver damage was found in IIM patients, whose elevated ALT excluding from injury liver,the impair muscle may be another source. Humoral immunity may dosen't play a key role in IIM correlated hepatic injury.