Dipartimento di Patologia Umana, University of Palermo, Italy.
Dig Liver Dis. 2010 Aug;42(8):585-92. doi: 10.1016/j.dld.2009.12.006. Epub 2010 Jan 13.
BACKGROUND/AIM: Plasma cells infiltrate in the liver is a prototype lesion of autoimmune liver diseases. The possible role of plasma cells isotyping (IgM and IgG) in the liver in the diagnostic definition of autoimmune liver disease, and particularly in variant syndromes such as autoimmune cholangitis and the primary biliary cirrhosis/autoimmune hepatitis overlap syndrome, is less defined.
We analysed the clinical, serological and histological features of 83 patients with autoimmune liver disease (40 primary biliary cirrhosis, 20 autoimmune hepatitis, 13 primary sclerosing cholangitis, 4 autoimmune cholangitis and 6 overlap syndrome) compared to 34 patients with chronic hepatitis C and evaluated the expression of IgM and IgG plasma cells in their liver by immunostaining.
By Spearman's correlation, the mean-counts of IgM plasma cells in portal tracts were significantly correlated with female gender, serum alkaline phosphatase, gamma-glutamyl transferase and IgM values, positivity for anti-mitochondrial antibody-M2 and, on liver biopsy, with bile duct changes, orcein-positive granules and granulomas. Whereas IgG plasma cells resulted more correlated with alanine aminotransferase levels. IgG/IgM ratio lower than 1 was found no only in primary biliary cirrhosis but also in all patients with autoimmune cholangitis. Conversely, all patients with overlap syndrome showed IgG/IgM ratio higher than 1.
Immunostaining for IgM and IgG plasma cells on liver tissue can be a valuable parameter for better diagnosis of autoimmune liver disease and also for variant or mixed syndromes.
背景/目的：浆细胞浸润肝脏是自身免疫性肝病的典型病变。浆细胞同型（IgM 和 IgG）在自身免疫性肝病的诊断定义中的可能作用，特别是在自身免疫性胆管炎和原发性胆汁性肝硬化/自身免疫性肝炎重叠综合征等变异综合征中，其作用定义尚不明确。
我们分析了 83 例自身免疫性肝病患者（40 例原发性胆汁性肝硬化、20 例自身免疫性肝炎、13 例原发性硬化性胆管炎、4 例自身免疫性胆管炎和 6 例重叠综合征）的临床、血清学和组织学特征，并与 34 例慢性丙型肝炎患者进行了比较，并通过免疫组化评估了他们肝脏中 IgM 和 IgG 浆细胞的表达。
通过 Spearman 相关分析，门脉区 IgM 浆细胞的平均计数与女性性别、血清碱性磷酸酶、γ-谷氨酰转移酶和 IgM 值、抗线粒体抗体-M2 阳性以及肝活检时胆管变化、奥辛阳性颗粒和肉芽肿呈显著相关。而 IgG 浆细胞与丙氨酸氨基转移酶水平的相关性更高。不仅在原发性胆汁性肝硬化中，而且在所有自身免疫性胆管炎患者中，都发现 IgG/IgM 比值低于 1。相反，所有重叠综合征患者的 IgG/IgM 比值均高于 1。
对肝组织中 IgM 和 IgG 浆细胞进行免疫组化染色可以作为更好地诊断自身免疫性肝病以及变异或混合综合征的有价值的参数。
