Goldstein N S, Soman A, Gordon S C
Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Am J Clin Pathol. 2001 Dec;116(6):846-53. doi: 10.1309/VHHD-HTRU-N8J2-5X7R.
We studied nondiagnostic liver biopsy specimens from 20 patients with definite primary biliary cirrhosis (PBC) and 18 with definite autoimmune hepatitis (AIH) to identify distinguishing features. All patients had early-stage disease; biopsy specimens were devoid of granulomas or diagnostic features of PBC or AIH. Diagnoses were based on serologic and clinical variables. Sixteen specimens from each group were immunostained with cytokeratin 7. The density of portal tract eosinophils and number with cytokeratin 7-reactive periportal hepatocytes were quantified. Sixteen of 18 patients with AIH and 13 of 20 with PBC had no or minimal bile duct injury. Histologic activity index scores were 5.8 in AIH and 5.7 in PBC. The mean portal eosinophil score was greater in PBC than in AIH. Cytokeratin 7 identified many central bile ducts that were obscured by portal inflammation. The mean periportal cytokeratin 7-reactive hepatocyte score was greater in PBC than in AIH. Portal eosinophils and cytokeratin 7 reactivity in periportal hepatocytes are supportive of PBC rather than AIH. No morphologic features were supportive of AIH. Cytokeratin 7 reactivity in periportal hepatocytes may be an early response to PBC-induced biliary obstruction in other regions of the liver.
我们研究了20例确诊为原发性胆汁性肝硬化（PBC）和18例确诊为自身免疫性肝炎（AIH）患者的非诊断性肝活检标本，以确定其鉴别特征。所有患者均处于疾病早期；活检标本无肉芽肿，也无PBC或AIH的诊断特征。诊断基于血清学和临床变量。每组16份标本用细胞角蛋白7进行免疫染色。对汇管区嗜酸性粒细胞密度和每例汇管区周围肝细胞细胞角蛋白7反应阳性的数量进行定量分析。18例AIH患者中有16例、20例PBC患者中有13例无或仅有轻微胆管损伤。AIH患者的组织学活动指数评分为5.8，PBC患者为5.7。PBC患者的平均汇管区嗜酸性粒细胞评分高于AIH患者。细胞角蛋白7识别出许多被汇管区炎症遮盖的中央胆管。PBC患者汇管区周围细胞角蛋白7反应阳性的肝细胞平均评分高于AIH患者。汇管区嗜酸性粒细胞和汇管区周围肝细胞中的细胞角蛋白7反应支持PBC而非AIH。没有形态学特征支持AIH。汇管区周围肝细胞中的细胞角蛋白7反应可能是肝脏其他区域对PBC诱导的胆管梗阻的早期反应。
