免疫介导的肝损伤：CD4 +、CD8 +和CD68 +在肝外胆道闭锁婴儿中的预后价值。

Immune-mediated liver injury: prognostic value of CD4+, CD8+, and CD68+ in infants with extrahepatic biliary atresia.

作者信息

Kotb Magd A, El Henawy Ahmed, Talaat Sahaar, Aziz Mona, El Tagy Gamal H, El Barbary Mohamed M, Mostafa Wael

机构信息

Department of Paediatrics, Cairo University, Cairo, Egypt.

出版信息

J Pediatr Surg. 2005 Aug;40(8):1252-7. doi: 10.1016/j.jpedsurg.2005.05.007.

DOI:10.1016/j.jpedsurg.2005.05.007

PMID:16080928

Abstract

BACKGROUND

Hepatic fibrosis and cirrhosis develop progressively in extrahepatic biliary atresia (EHBA) despite timely surgical intervention.

PURPOSE

The aim of the study was to define CD4+ helper T lymphocytes, cytotoxic CD8+ T lymphocytes, and CD68+ (macrophages) infiltration of portal tracts and lobules and hepatic fibrosis as possible predictive measures of outcome of infants having EHBA.

METHODS

The outcome of 32 infants with EHBA was correlated to their percutaneous biopsy and postportoenterostomy core liver tissue infiltration by CD4+, CD68+, and CD8+ cells and to the degree of detected fibrosis.

RESULTS

Portoenterostomy cores were heavily infiltrated by CD4+, CD8+, and CD68+, compared with the preoperative liver biopsy (P = .008, .004, and .017, respectively). Infants having favorable outcome had more macrophage infiltration in portoenterostomy core compared with those having an unfavorable outcome (25.66 +/- 29.77 per HPF compared with 11.62 +/- 4.58, P = .000). Mean CD4+/CD8+ ratio was 1.54 +/- 1.37 in those who died within 18 months postoperatively and 0.733 +/- 0.48 in others (P = .021).

CONCLUSION

Immune-mediated destruction of portal tracts is an integral part of pathogenesis of EHBA.

摘要

背景

尽管进行了及时的手术干预，但肝外胆道闭锁（EHBA）患儿的肝纤维化和肝硬化仍会逐渐发展。

目的

本研究旨在确定门静脉周围和肝小叶中CD4 +辅助性T淋巴细胞、细胞毒性CD8 + T淋巴细胞和CD68 +（巨噬细胞）的浸润情况以及肝纤维化程度，作为预测EHBA患儿预后的可能指标。

方法

对32例EHBA患儿的预后与经皮肝穿刺活检及门腔静脉吻合术后肝组织中CD4 +、CD68 +和CD8 +细胞的浸润情况以及检测到的纤维化程度进行相关性分析。

结果

与术前肝活检相比，门腔静脉吻合术后肝组织中CD4 +、CD8 +和CD68 +浸润严重（P值分别为0.008、0.004和0.017）。预后良好的患儿门腔静脉吻合术后肝组织中的巨噬细胞浸润多于预后不良的患儿（每高倍视野分别为25.66±29.77和11.62±4.58，P = 0.000）。术后18个月内死亡患儿的平均CD4 + / CD8 +比值为1.54±1.37，其他患儿为0.733±0.48（P = 0.021）。