Department of Pathology, Columbia University College of Physicians & Surgeons, 630 W168th Street VC14-238B, New York, NY 10032, USA.
World J Gastroenterol. 2010 Jan 28;16(4):453-7. doi: 10.3748/wjg.v16.i4.453.
To assess the role of IgM and IgG immunohistochemistry (IHC) in the evaluation of autoimmune liver conditions--autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC).
Forty one biopsies from untreated patients diagnosed with autoimmune liver disease (AIH, n = 20; PBC, n = 13; PSC, n = 8) and fourteen biopsies of patients with chronic hepatitis C were selected. IgM and IgG-positive plasma cells were counted in each sample.
A predominance of IgG-positive plasma cells was seen in AIH (90% of cases), PSC (75% of cases), and chronic hepatitis C (100% of cases), while IgM-positive plasma cells predominated in PBC (92.8% of cases). The IgM /IgG ratio (< 1 or > or = 1) accurately distinguished PBC from AIH in 90.9% of cases (sensitivity = 92.3%, specificity = 90%), and PBC from either AIH or PSC in 87.8% of cases (sensitivity = 92.3%, specificity = 85.7%).
Plasmacytic infiltrates expressing predominantly IgM are characteristic of PBC, while other forms of liver disease analyzed in this study, including AIH, typically show an IgG-predominant plasma cell infiltrate. Our data indicate that IgM and IgG IHC may be a useful tool when PBC is a diagnostic consideration.
评估 IgM 和 IgG 免疫组织化学（IHC）在评估自身免疫性肝病（自身免疫性肝炎 [AIH]、原发性胆汁性肝硬化 [PBC] 和原发性硬化性胆管炎 [PSC]）中的作用。
选择 41 例未经治疗的自身免疫性肝病患者（AIH，n = 20；PBC，n = 13；PSC，n = 8）和 14 例慢性丙型肝炎患者的活检组织。在每个样本中计算 IgM 和 IgG 阳性浆细胞的数量。
AIH（90%的病例）、PSC（75%的病例）和慢性丙型肝炎（100%的病例）中可见 IgG 阳性浆细胞占优势，而 IgM 阳性浆细胞在 PBC 中占优势（92.8%的病例）。IgM/IgG 比值（<1 或≥1）在 90.9%的病例中准确地区分了 PBC 与 AIH（敏感性 = 92.3%，特异性 = 90%），在 87.8%的病例中区分了 PBC 与 AIH 或 PSC（敏感性 = 92.3%，特异性 = 85.7%）。
表达主要为 IgM 的浆细胞浸润是 PBC 的特征，而本研究分析的其他肝病形式，包括 AIH，通常表现为 IgG 占优势的浆细胞浸润。我们的数据表明，当考虑 PBC 作为诊断时，IgM 和 IgG IHC 可能是一种有用的工具。
