天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (7): 692-695.doi: 10.11958/20180078

• 临床研究 • 上一篇    下一篇

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

熊希倩 1，詹江华 2△，胡晓丽 3，齐美娇 3   

  1. 1天津医科大学研究生院（邮编300070）；2天津市儿童医院普外科，天津市儿科研究所；3天津市儿童医院病理科
  • 收稿日期:2018-01-15 修回日期:2018-05-30 出版日期:2018-07-15 发布日期:2018-07-15
  • 通讯作者: 詹江华 E-mail:zhanjianghuatj@163.com
  • 基金资助:
    国家自然科学基金资助项目;天津市卫生行业重点攻关项目

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

XIONG Xi-qian1, ZHAN Jiang-hua2△, HU Xiao-li3, QI Mei-jiao3   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Department of Pediatric Surgery, Tianjin Children’s Hospital, Tianjin Institute of Pediatrics, 3 Department of Pathology, Tianjin Children’s Hospital △Corresponding Author E-mail: zhanjianghuatj@163.com
  • Received:2018-01-15 Revised:2018-05-30 Published:2018-07-15 Online:2018-07-15
  • Contact: zhanjianghua E-mail:zhanjianghuatj@163.com
  • Supported by:
    ;Fund program:High-Priority Health Projects of Tianjin

PDF (PC)

3888

摘要： 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。

关键词: 胆道闭锁, 肝硬化, 胆管炎, 炎性浸润, Kasai手术

Abstract: 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 grade Ⅰgroup (n=8), hepatic fibrosis grade Ⅱ group (n=31), hepatic fibrosis grade Ⅲ group (n= 35) and hepatic fibrosis grade Ⅳ group (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 group Ⅳ compared with those of group Ⅱ and group Ⅲ . 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 group Ⅰ and group Ⅳ than that in group Ⅱ and group Ⅲ .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.

Key words: biliary atresia, liver cirrhosis, cholangitis, inflammatory infiltrates, Kasai operation