Verdonk Robert C, Lozano Mallaki F, van den Berg Aad P, Gouw Annette S H
Department of Gastroenterology & Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Pathology Medical Biology, Pathology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Liver Int. 2016 Sep;36(9):1362-9. doi: 10.1111/liv.13083. Epub 2016 Mar 14.
BACKGROUND & AIMS: The significance of bile duct injury and ductular reaction in biopsies from autoimmune hepatitis patients is not clear. We aim to establish the prevalence and clinical relevance of both phenomena in autoimmune hepatitis.
Cases of newly diagnosed, untreated autoimmune hepatitis without overlap syndrome were selected. Pretreatment and follow up biopsies were scored for inflammation, fibrosis, bile ductal injury and ductular reaction.
Thirty-five cases were studied of whom 14 cases had follow up biopsies. Bile duct injury was present in 29 cases (83%), mostly in a PBC-like pattern and was not correlated with demographical or laboratory findings. Ductular reaction, observed in 25 of 35 cases (71%) using conventional histology and in 30 of 32 cases (94%) using immunohistochemistry, was correlated with portal and lobular inflammation, interface hepatitis and centrilobular necrosis as well as bile duct injury and fibrosis. In 11 of 14 cases (79%) ductular reaction remained present on post-treatment biopsy whereas bile duct injury persisted in six of 14 (43%) of cases.
Bile duct injury and ductular reaction are very common in newly diagnosed autoimmune hepatitis and cannot be predicted biochemically. Bile duct injury may subside in the majority of treated AIH cases while DR tends to persist during follow up. These findings show that the two phenomena are part of the spectrum of AIH with dissimilar responses to treatment and do not necessarily point towards an overlap syndrome. Persistence of ductular reaction after treatment supports the notion that it represents a regenerative response.
自身免疫性肝炎患者活检中胆管损伤和小胆管反应的意义尚不清楚。我们旨在确定这两种现象在自身免疫性肝炎中的发生率及其临床相关性。
选取新诊断的、未接受治疗且无重叠综合征的自身免疫性肝炎病例。对治疗前和随访活检的炎症、纤维化、胆管损伤和小胆管反应进行评分。
共研究了35例病例，其中14例进行了随访活检。29例（83%）存在胆管损伤，大多呈原发性胆汁性胆管炎样模式，且与人口统计学或实验室检查结果无关。使用传统组织学方法，35例中有25例（71%）观察到小胆管反应，使用免疫组化方法，32例中有30例（94%）观察到小胆管反应，小胆管反应与门管区和小叶炎症、界面性肝炎、中央静脉周围坏死以及胆管损伤和纤维化相关。14例中有11例（79%）在治疗后活检时仍存在小胆管反应，而14例中有6例（43%）胆管损伤持续存在。
胆管损伤和小胆管反应在新诊断的自身免疫性肝炎中非常常见，无法通过生化指标预测。大多数接受治疗的自身免疫性肝炎病例中胆管损伤可能消退，而小胆管反应在随访期间往往持续存在。这些发现表明这两种现象是自身免疫性肝炎谱的一部分，对治疗有不同反应，不一定提示重叠综合征。治疗后小胆管反应持续存在支持了其代表一种再生反应的观点。
