CAJ | 학술논문

目的了解肝移植术后丙型肝炎复发患者肝脏纤维化进展情况及其与肝组织中免疫细胞分布的关系.方法对2005年4月至2012年12月解放军第三○二医院34例肝移植术后丙型肝炎复发患者的58次肝脏穿刺(肝穿)组织和15份非移植慢性丙型肝炎患者的肝组织进行病理分析,行Metavir评分,同时对其中15例行2～4次肝穿的39份样本做CD4+、CD8+、CD20+、CD57+细胞的免疫组织化学染色.采用x2检验和方差分析肝纤维化进展情况与病理特点、CD4+、CD8+T淋巴细胞,B淋巴细胞和NK细胞分布的关系.结果 34例肝移植术后丙型肝炎复发患者肝纤维化发展速度中位数为1/年,其中9例(26.47％)为快进展型,移植术后1年内肝纤维化发展速度＞2(Metavir评分),其余25例(73.53％)慢进展型患者肝纤维化发展速度中位数为0.6/年.与非移植慢性丙型肝炎患者肝脏病理学改变相比,移植后丙型肝炎复发患者肝脏病理改变以汇管区水肿、小叶间胆管损伤、界面炎、小叶内凋亡小体增多为特点,其中界面炎随肝纤维化加重而增多(x2=9.656,P=0.008).肝组织中CD4+、CD8+T淋巴细胞,B淋巴细胞的表达量随肝脏纤维化程度加重而增多,NK细胞表达量则随肝脏纤维化程度加重而减少.相同纤维化程度的快进展型与慢进展型患者,肝组织中免疫细胞的数量差异无统计学意义(P值均＞0.05).结论肝移植术后部分丙型肝炎复发患者肝纤维化发展速度较快.随肝脏纤维化程度加重,肝组织中CD4+、CD8+T淋巴细胞,B淋巴细胞的表达增多,NK细胞表达减少.
목적 료해간이식술후병형간염복발환자간장섬유화진전정황급기여간조직중면역세포분포적관계.방법 대2005년4월지2012년12월해방군제삼○이의원34례간이식술후병형간염복발환자적58차간장천자(간천)조직화15빈비이식만성병형간염환자적간조직진행병리분석,행Metavir평분,동시대기중15례행2～4차간천적39빈양본주CD4+、CD8+、CD20+、CD57+세포적면역조직화학염색.채용x2검험화방차분석간섬유화진전정황여병리특점、CD4+、CD8+T림파세포,B림파세포화NK세포분포적관계.결과 34례간이식술후병형간염복발환자간섬유화발전속도중위수위1/년,기중9례(26.47％)위쾌진전형,이식술후1년내간섬유화발전속도＞2(Metavir평분),기여25례(73.53％)만진전형환자간섬유화발전속도중위수위0.6/년.여비이식만성병형간염환자간장병이학개변상비,이식후병형간염복발환자간장병리개변이회관구수종、소협간담관손상、계면염、소협내조망소체증다위특점,기중계면염수간섬유화가중이증다(x2=9.656,P=0.008).간조직중CD4+、CD8+T림파세포,B림파세포적표체량수간장섬유화정도가중이증다,NK세포표체량칙수간장섬유화정도가중이감소.상동섬유화정도적쾌진전형여만진전형환자,간조직중면역세포적수량차이무통계학의의(P치균＞0.05).결론 간이식술후부분병형간염복발환자간섬유화발전속도교쾌.수간장섬유화정도가중,간조직중CD4+、CD8+T림파세포,B림파세포적표체증다,NK세포표체감소.
Objective To evaluate liver fibrosis progression and intrahepatic lymphocytes distribution in liver transplantation patients with hepatitis C virus (HCV) recurrence.Methods A total of 58 liver biopsy samples were collected from 34 HCV patients who underwent liver transplantation in the 302 Hospital of PLA during April 2005 and December 2012.Fifteen liver biopsy samples from patients with chronic hepatitis C were also collected as controls.The histopathological examinations were performed and Metavir scores were evaluated on above samples.CD4 and CD8 T-lymphocytes,CD20 (B lymphocytes),and CD57 (NK) cells were detected using immunohistochemical staining in 39 biopsy samples from 15 liver transplantation patients with HCV recurrence.x2 test and analysis of variance were used to analyze the relationship of the progress of liver fibrosis with pathological characteristics and the distribution of CD4 +,CD8 + T cells,B cells and NK cells.Results Liver fibrosis developed with a median of 1 metavir score/y in 34 liver transplantation patients with HCV recurrence,including 9 (26.47％) with ＞ 2 metavir score/y (fast progression) and 25 (73.53％) with 0.6 Metavir score/y (slow progression).Compared with the HCV patients with no liver transplantation,liver tissues of liver transplantation patients were characterized by portal area edema,damage of interlobular bile ducts,interface inflammation,and increased apoptotic body within the lobule,and the interface inflammation was more commonly in advanced fibrosis liver tissues (x2 =9.656,P =0.008).CD4,CD8,and CD20 + lymphocytes increased in parallel with fibrosis,while CD57 + NK cells decreased.The numbers of immune cells in liver tissues at same stage of fibrosis from patients with fast and slow liver fibrosis progression had no significant difference (P ＞ 0.05).Conclusions Some liver transplantation patients with HCV recurrence may develop advanced fibrosis marked with elevated metavir score ＞ 2/y,which are parallel with the increased CD4,CD8,CD20 + lymphocytes and decreased CD57 + cells in liver tissue.