【摘要】：[目的] 研究自身免疫性肝病的病理特點(diǎn),尋找有效的病理診斷指標(biāo)。 [方法] 選擇2006年—2012年昆明醫(yī)科大學(xué)病理教研室肝穿活檢病例1883例,從中篩選病理診斷為原發(fā)性膽汁性肝硬化(primary biliary cirrhosis,PBC)血清檢測(cè)AMA-M2陽(yáng)性病例30例、AMA-M2陰性17例和自身免疫性肝炎(autoimmune hepatitis,AIH)病例20例。采用D-PAS特殊染色觀(guān)察門(mén)管區(qū)的病變情況,采用免疫組化方法檢測(cè)肝組織內(nèi)IgG、IgM、PDC-E2、 CD11c的表達(dá)情況。 [結(jié)果] 1、D-PAS特殊染色能勾勒出膽管上皮基底膜的輪廓,有利于了解門(mén)管區(qū)膽管的損傷情況。 2、免疫組化檢測(cè)顯示： IgM、IgG陽(yáng)性顆粒主要分布于肝臟門(mén)管區(qū)漿細(xì)胞胞漿內(nèi),PDC-E2陽(yáng)性顆粒表達(dá)于膽管上皮細(xì)胞及肝細(xì)胞的胞漿內(nèi),CDllc陽(yáng)性顆粒表達(dá)于肝臟門(mén)管區(qū)樹(shù)突狀細(xì)胞的胞漿內(nèi)。PBC AMA-M2陽(yáng)性組、PBC AMA-M2陰性組、AIH組三組內(nèi)IgM、IgG含量相比差異均有統(tǒng)計(jì)學(xué)意義(P0.05), PBC患者肝臟門(mén)管區(qū)漿細(xì)胞內(nèi)主要表達(dá)IgM, AIH患者肝臟門(mén)管區(qū)漿細(xì)胞內(nèi)主要表達(dá)IgG,; PBC AMA-M2陽(yáng)性組與AMA-M2陰性組相比,AMA-M2陽(yáng)性的PBC患者肝臟門(mén)管區(qū)IgM、IgG陽(yáng)性表達(dá)比AMA-M2陰性的PBC患者的高,IgM、IgG含量差異有統(tǒng)計(jì)學(xué)意義(P0.05)。PBC AMA-M2陽(yáng)性組、PBC AMA-M2陰性組、AIH組兩兩相比,PDC-E2陽(yáng)性單位相比差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。PBC AMA-M2陽(yáng)性組、PBC AMA-M2陰性組、AIH組兩兩相比,PBC AMA-M2陽(yáng)性組、PBCAMA-M2陰性組CD11c陽(yáng)性單位相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),余兩兩相比CD11c陽(yáng)性單位差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 [結(jié)論] 1、D-PAS特殊染色能顯示肝臟門(mén)管區(qū)膽管基底膜的損傷情況,并且更直觀(guān)的顯示膽管數(shù)目的增減情況。 2、PBC患者肝臟門(mén)管區(qū)漿細(xì)胞內(nèi)主要表達(dá)IgM, AIH患者肝臟門(mén)管區(qū)漿細(xì)胞內(nèi)主要表達(dá)IgG,肝組織中IgM和IgG的檢測(cè)及分析有助于自身免疫性肝病的診斷。且AMA-M2陽(yáng)性的PBC患者肝臟門(mén)管區(qū)IgM.IgG陽(yáng)性表達(dá)比AMA-M2陰性的PBC患者的高。 3、肝穿活檢組織PDC-E2免疫組化檢測(cè)有助于PBC的診斷,且在A(yíng)MA-M2陽(yáng)性和AMA-M2陰性的PBC的表達(dá)有一定的差異。 4、CD11c主要表達(dá)于肝臟門(mén)管區(qū)肉芽腫內(nèi),有助于PBC的診斷。
[Abstract]:Objective: to study the pathological features of autoimmune liver disease and to search for effective pathological diagnosis index. [methods] 1883 cases of liver biopsy were selected from 2006 to 2012 in the Department of Pathology, Kunming Medical University. Thirty cases of AMA-M2 positive, 17 cases of AMA-M2 negative and 20 cases of autoimmune hepatitis (autoimmune hepatitis,AIH) were screened from pathological diagnosis of primary biliary cirrhosis (primary biliary cirrhosis,PBC). The results were as follows: (1) there were 30 cases of AMA-M2 positive, 17 cases of AMA-M2 negative and 20 cases of autoimmune hepatitis (autoimmune hepatitis,AIH). The pathological changes of portal area were observed by D-PAS staining and the expression of IgG,IgM,PDC-E2, CD11c in liver tissue was detected by immunohistochemical method. [results] 1D-PAS special staining could outline the basal membrane of bile duct epithelium. 2Immunohistochemical examination showed that IgM,IgG positive granules were mainly distributed in the cytoplasm of hepatic hilar duct plasma cells, and PDC-E2 positive granules were expressed in bile duct epithelial cells. CDllc positive granules were expressed in the cytoplasm of dendritic cells in hepatic portal area. There were significant differences in IgM,IgG content among three groups: PBC AMA-M2 positive group, PBC AMA-M2 negative group and AIH group (P0.05). Compared with AMA-M2 negative group, the positive expression of IgM,IgG in AMA-M2 positive PBC patients was higher than that in AMA-M2 negative PBC patients, and IgM,IgG content was different. Statistical significance (P0.05). PBC AMA-M2 positive group, PBC AMA-M2 negative group, AIH group compared with each other, PDC-E2 positive group, PBC AMA-M2 negative group, AIH group, PBC AMA-M2 positive group, PBCAMA-M2 negative group CD11c positive unit difference was statistically significant (P0.05). There was no statistical significance (P0.05), the other two compared with the CD11c positive unit difference was statistically significant (P0.05). [conclusion] 1D-PAS special staining can show the damage of bile duct basement membrane in hepatic hilar area. The expression of IgM and IgG in liver tissues of patients with IgM, AIH was mainly detected and analyzed. Assist in the diagnosis of autoimmune liver disease. The positive expression of IgM.IgG in PBC patients with AMA-M2 positive was higher than that in PBC patients with AMA-M2 negative. The immunohistochemical detection of PDC-E2 in liver biopsy tissue was helpful for the diagnosis of PBC. The expression of CD11c was mainly expressed in hepatic hilar granuloma, which was helpful for the diagnosis of PBC.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R575

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