中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2014年
8期
521-526
,共6页
刘象%徐芸%汪群英%保洁%吴凤娟
劉象%徐蕓%汪群英%保潔%吳鳳娟
류상%서예%왕군영%보길%오봉연
肝炎,自身免疫性%IgG4%IgG4相关性疾病%病理学,临床
肝炎,自身免疫性%IgG4%IgG4相關性疾病%病理學,臨床
간염,자신면역성%IgG4%IgG4상관성질병%병이학,림상
Hepatitis,autoimmune%IgG4%IgG4-related disease%Pathology,clinical
目的 探讨Ⅰ型自身免疫性肝炎(AIH)患者肝脏组织学IgG4的表达,及其临床表现、生物化学指标、免疫及遗传学特性、病理学表现及免疫抑制治疗效果.方法 纳入2012年3月至2013年7月确诊的AIH-Ⅰ型患者45例,对其肝脏组织切片进行CD38、IgG、IgG4免疫组织化学染色,同时进行炎性反应分级G、纤维化分期S,并收集患者相应的血清学指标(ALT、AST、ALP、IgG、抗核抗体效价、去唾液酸糖蛋白受体抗体(ASGPRAb),血清IgG4测定,进一步研究免疫抑制治疗后的应答反应.定量资料比较采用t检验和Wilcoxon秩和检验,Spearman相关系数表示相关性.结果 45例AIH-Ⅰ型患者中5例(11.1％)为IgG4相关性AIH(IgG4-AIH组),其与经典AIH组患者(40例)在年龄、性别、生物化学指标(ALT、AST、ALP水平)、免疫指标(IgG水平、抗核抗体效价、ASGPRAb阳性率)及组织纤维化程度等方面差异均无统计学意义(P均＞0.05).IgG4-AIH组的血清IgG水平为25.8(9.2) mg/L,明显高于经典AIH组的18.3(6.7) mg/L(Z=-2.041,P＜0.05),但两组之间血清IgG4水平差异并无统计学意义(P＞0.05),同时可见肝脏组织IgG4浆细胞浸润个数与血清IgG4水平无相关性(r=0.311,P=0.279).IgG4-AIH组患者的肝脏组织炎性反应情况较经典AIH组更显著(H＝4.120,P＜0.05),CD38+、IgG+浆细胞表达相对较经典AIH组更显著(CD38每个高倍视野下个数分别为39.3(13.5)的和21.3(8.8),IgG分别为39.3(14.0)和18.5(8.9);Z＝-3.561,-3.584;P均＜0.01).肝脏组织中IgG4+浆细胞个数与CD38+、IgG+浆细胞个数呈正相关(r=0.884,0.791;P均＜0.01).结论 AIH-Ⅰ型患者中存在IgG4相关性AIH,但发病率不高.IgG4相关性AIH患者血清IgG4水平未显著升高,但组织学炎性反应活动较显著,并伴随较多CD38+、IgG-浆细胞浸润.
目的 探討Ⅰ型自身免疫性肝炎(AIH)患者肝髒組織學IgG4的錶達,及其臨床錶現、生物化學指標、免疫及遺傳學特性、病理學錶現及免疫抑製治療效果.方法 納入2012年3月至2013年7月確診的AIH-Ⅰ型患者45例,對其肝髒組織切片進行CD38、IgG、IgG4免疫組織化學染色,同時進行炎性反應分級G、纖維化分期S,併收集患者相應的血清學指標(ALT、AST、ALP、IgG、抗覈抗體效價、去唾液痠糖蛋白受體抗體(ASGPRAb),血清IgG4測定,進一步研究免疫抑製治療後的應答反應.定量資料比較採用t檢驗和Wilcoxon秩和檢驗,Spearman相關繫數錶示相關性.結果 45例AIH-Ⅰ型患者中5例(11.1％)為IgG4相關性AIH(IgG4-AIH組),其與經典AIH組患者(40例)在年齡、性彆、生物化學指標(ALT、AST、ALP水平)、免疫指標(IgG水平、抗覈抗體效價、ASGPRAb暘性率)及組織纖維化程度等方麵差異均無統計學意義(P均＞0.05).IgG4-AIH組的血清IgG水平為25.8(9.2) mg/L,明顯高于經典AIH組的18.3(6.7) mg/L(Z=-2.041,P＜0.05),但兩組之間血清IgG4水平差異併無統計學意義(P＞0.05),同時可見肝髒組織IgG4漿細胞浸潤箇數與血清IgG4水平無相關性(r=0.311,P=0.279).IgG4-AIH組患者的肝髒組織炎性反應情況較經典AIH組更顯著(H＝4.120,P＜0.05),CD38+、IgG+漿細胞錶達相對較經典AIH組更顯著(CD38每箇高倍視野下箇數分彆為39.3(13.5)的和21.3(8.8),IgG分彆為39.3(14.0)和18.5(8.9);Z＝-3.561,-3.584;P均＜0.01).肝髒組織中IgG4+漿細胞箇數與CD38+、IgG+漿細胞箇數呈正相關(r=0.884,0.791;P均＜0.01).結論 AIH-Ⅰ型患者中存在IgG4相關性AIH,但髮病率不高.IgG4相關性AIH患者血清IgG4水平未顯著升高,但組織學炎性反應活動較顯著,併伴隨較多CD38+、IgG-漿細胞浸潤.
목적 탐토Ⅰ형자신면역성간염(AIH)환자간장조직학IgG4적표체,급기림상표현、생물화학지표、면역급유전학특성、병이학표현급면역억제치료효과.방법 납입2012년3월지2013년7월학진적AIH-Ⅰ형환자45례,대기간장조직절편진행CD38、IgG、IgG4면역조직화학염색,동시진행염성반응분급G、섬유화분기S,병수집환자상응적혈청학지표(ALT、AST、ALP、IgG、항핵항체효개、거타액산당단백수체항체(ASGPRAb),혈청IgG4측정,진일보연구면역억제치료후적응답반응.정량자료비교채용t검험화Wilcoxon질화검험,Spearman상관계수표시상관성.결과 45례AIH-Ⅰ형환자중5례(11.1％)위IgG4상관성AIH(IgG4-AIH조),기여경전AIH조환자(40례)재년령、성별、생물화학지표(ALT、AST、ALP수평)、면역지표(IgG수평、항핵항체효개、ASGPRAb양성솔)급조직섬유화정도등방면차이균무통계학의의(P균＞0.05).IgG4-AIH조적혈청IgG수평위25.8(9.2) mg/L,명현고우경전AIH조적18.3(6.7) mg/L(Z=-2.041,P＜0.05),단량조지간혈청IgG4수평차이병무통계학의의(P＞0.05),동시가견간장조직IgG4장세포침윤개수여혈청IgG4수평무상관성(r=0.311,P=0.279).IgG4-AIH조환자적간장조직염성반응정황교경전AIH조경현저(H＝4.120,P＜0.05),CD38+、IgG+장세포표체상대교경전AIH조경현저(CD38매개고배시야하개수분별위39.3(13.5)적화21.3(8.8),IgG분별위39.3(14.0)화18.5(8.9);Z＝-3.561,-3.584;P균＜0.01).간장조직중IgG4+장세포개수여CD38+、IgG+장세포개수정정상관(r=0.884,0.791;P균＜0.01).결론 AIH-Ⅰ형환자중존재IgG4상관성AIH,단발병솔불고.IgG4상관성AIH환자혈청IgG4수평미현저승고,단조직학염성반응활동교현저,병반수교다CD38+、IgG-장세포침윤.
Objective To investigate the expression of IgG4 in liver tissues of patients with type Ⅰ autoimmune hepatitis (AIH) and to analyze the clinical manifestation,biochemical indexes,immunological genetic features,pathological characteristics and the effects of immunosuppressive therapy.Methods From March 2012 to July 2013,45 patients diagnosed as type Ⅰ AIH were enrolled.Immunostaining of CD38,IgG and IgG4 in liver tissue slices was performed,inflammation grade G and fibrosis stage S were determined.At the same time,serological indexes (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),IgG,antinuclear antibody (ANA) titer,antibodies to asialoglycoprotein receptor (ASGPRAb)) of the patients were collected,serum IgG4 was tested and the response to immunosuppressive therapy was observed.Wilcoxon rank sum test and t test were performed for quantitative data comparison.Spearman correlation coefficient was used for correlation analysis.Results Among 45 patients with type Ⅰ AIH,five patients (11.1％) were IgG4 associated AIH (IgG4-AIH group).There were no significant differences in age,gender,biochemical indexes (serum levels of ALT,AST,ALP),immunity indexes (serum levels of IgG,ANA titer,ASGPRAb) and degree of liver fibrosis between patients with IgG4-associated AIH and classical AIH (40 cases) (all P＞ 0.05).Compared with classical AIH group (18.3(6.7) mg/L).The serum level of IgG4 of IgG4 AIH group was 25.8(9.2) mg/L,which significantly increased (Z=-2.041,P＜0.05).However,there was no significant difference in serum level of IgG4 between the two groups (P＞0.05).There was no correlation between the number of infiltrated IgG4 positive plasma cells and the serum level of IgG4 (r=0.311,P=0.279).The inflammation in the liver tissues of IgG4-AIH group was more significant compared with that of classic AIH group (H=4.120,P＜0.05).The number of CD38' or IgG+ plasma cells was larger compared with that of classical AIH (CD38(39.3(13.5)/high power field (HPF) vs (21.3(8.8))/HPF,IgG(39.3 (14.0))/HPFvs (18.5(8.9))/HPF;Z ＝-3.561 and-3.584,both P＜0.01).The number of IgG4+ plasma cells in liver tissues was positively correlated with the number of CD38+ or IgG+ plasma cells (r=0.884 and 0.791,both P＜0.01).Conclusions Among patients with type Ⅰ AIH,the incidence of IgG4-associated AIH was not high.The serum level of IgG4 did not significantly increase in these patients.However,the histological inflammation activity was significant along with many CD38+ or IgG+ plasma cells infiltration.
