CAJ | 학술논문

目的了解胆道闭锁肝脏组织和残存胆道组织中T细胞的主要类型及其与Kasai术后胆管炎的关系.方法应用免疫组织化学的方法对22例胆道闭锁患儿(早期胆管炎和非胆管炎各11例进行配对)肝组织标本和肝门纤维块标本与13例其他肝胆道疾病患儿肝组织标本进行对比研究.同时结合胆管炎的发生与否分析免疫组化结果与Kasai术后胆管炎相关性.结果胆道闭锁患儿肝脏组织和肝门纤维块内有大量CD4+T细胞和CD8+T细胞浸润(与对照组相比均P=0.000).胆道闭锁组与对照组中CD57+的NK细胞均为阴性.颗粒酶B在胆道闭锁组与对照胆道闭锁组中均为阴性.早期胆管炎组CD8+T细胞数量明显低于非胆管炎组(P=0.002).CD8+T评分与早期胆管炎的发生呈负相关,相关系数R=-0.674(P=0.001).结论在Kasai手术之前患儿的肝脏组织和残存的胆道组织中有大量CD4+T和CD8+T细胞浸润,而颗粒酶B的杀伤途径不参与胆道闭锁的免疫损伤.CD8+T细胞浸润程度与胆管炎的发生有明显负相关,其对胆道闭锁肝内的损伤性炎症反应可能具有保护性免疫调节作用.
목적 료해담도폐쇄간장조직화잔존담도조직중T세포적주요류형급기여Kasai술후담관염적관계.방법 응용면역조직화학적방법대22례담도폐쇄환인(조기담관염화비담관염각11례진행배대)간조직표본화간문섬유괴표본여13례기타간담도질병환인간조직표본진행대비연구.동시결합담관염적발생여부분석면역조화결과여Kasai술후담관염상관성.결과 담도폐쇄환인간장조직화간문섬유괴내유대량CD4+T세포화CD8+T세포침윤(여대조조상비균P=0.000).담도폐쇄조여대조조중CD57+적NK세포균위음성.과립매B재담도폐쇄조여대조담도폐쇄조중균위음성.조기담관염조CD8+T세포수량명현저우비담관염조(P=0.002).CD8+T평분여조기담관염적발생정부상관,상관계수R=-0.674(P=0.001).결론 재Kasai수술지전환인적간장조직화잔존적담도조직중유대량CD4+T화CD8+T세포침윤,이과립매B적살상도경불삼여담도폐쇄적면역손상.CD8+T세포침윤정도여담관염적발생유명현부상관,기대담도폐쇄간내적손상성염증반응가능구유보호성면역조절작용.
Objective To investigate the correlation between CD4/CD8 + T lymphocytes in por-tal area and remnant bile duct tissue and early cholangitis after Kasai operation for patients with biliary atresia(BA) . Methods Specimens of liver and portal fibrous mass from 22 patients with BA, as well as liver from 13 patients with other hepatobiliary diseases which served as a control, were collected. Immunohistochemical staining was used for the analysis of CD4/CD8 + T lymphocytes in these speci-mens. The correlation between immunohistochemical staining and early cholangitis after Kasai opera-tion was analyzed. Results Compared with the control group, the quantity of infiltrative CD4 + lym-phocytes and CD8 + lymphocytes significantly increased in liver and portal fibrous mass of infants with BA (P = 0.000). CD57 + NK cells and cytotoxic marker granzyme B were both negative in BA group and control group. The quantity of infiltrative CD8 + lymphocytes was significantly less in the group with early cholangitis than that without early cholangitis group (P = 0.002). Negative correlation was noted between the onset of early cholangitis and the quantity of infiltrative CD8 + T cells with a coeffi-cient correlation of - 0.674 (P = 0.001). Conclusions CD4 + and CD8 + lymphocytes predominate over liver and portal fibrous mass of infants with BA. Granzyme B pathway does not contribute in im-munological injury during the process of BA. A significant negative correlation was noted in the quan-tity of infiltrative CD8 + T cells and onset of cholangitis, indicating that CD8 + T cells may play an important protective role in immune response against intrahepatic inflammatory injury in patients with BA.