Liu L W, Liu J M, Luo J, Yang R Y, Li K X, Zhu Z J, Sun L Y, Zhao X Y
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China.
Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Ontario L8S4L8, Canada.
Zhonghua Gan Zang Bing Za Zhi. 2021 Feb 20;29(2):150-155. doi: 10.3760/cma.j.cn501113-20200216-00048.
To analyze the clinicopathological characteristics and intrahepatic immune cells infiltration condition after Kasai biliary atresia surgery. Data of 28 cases who underwent liver transplantation in the liver transplantation center of our hospital from June 2017 to March 2019 were enrolled. Of which, 20 cases were in the biliary atresia group (divided into two subgroups: 10 cases without Kasai surgery and 10 cases after Kasai surgery, and latter subsided cholestasis) and 8 cases in the control group. Clinical and pathological morphological characteristics of the groups were compared. Liver tissue sections were stained with immunohistochemistry and CD3, CD4, CD8, CD20, Foxp3, and interleukin-17A were quantitatively analyzed. Kruskal-Wallis test was used to measure the above indicators, and rank-sum test or Fisher's exact test was used to compare the count data. The degree of clinical and pathological cholestasis in the biliary atresia group after Kasai surgery was significantly lower than that of the group without Kasai surgery, and the degree of liver fibrosis was also significantly reduced ( < 0.05), but there was no statistically significant difference in the degree of inflammation in the portal vein area between the two groups ( > 0.05). There was statistically significant difference in the types of immune cells infiltrated in the liver ( < 0.05). Compared with the group without Kasai surgery, the infiltration of CD3, CD8, IL-17A and Foxp3 positive cells in the portal vein area after Kasai surgery group ( < 0.05) was significantly reduced, but there was no statistically significant difference in the proportion of Foxp3/CD4 positive cells between the two groups ( > 0.05), which continued to be lower than that of the control group ( < 0.05). Compared with the non-Kasai surgery group, the proportion of Foxp3/IL-17A and Foxp3/CD8 positive cells in the portal vein area did not increase significantly after Kasai surgery group ( > 0.05), and remained lower than the control group. However, the proportion of Foxp3/IL-17A and Foxp3/CD8 positive cells was significantly reduced ( < 0.05). Intrahepatic inflammatory cell infiltration and regulatory/effector T lymphocyte proportion dysregulation exist in patients with subsided cholestasis after Kasai biliary atresia surgery, which may be an important factor to promote the disease progression.
分析Kasai胆道闭锁手术后的临床病理特征及肝内免疫细胞浸润情况。纳入我院肝移植中心2017年6月至2019年3月行肝移植的28例患者资料。其中，胆道闭锁组20例（分为两个亚组：未行Kasai手术10例，Kasai手术后胆汁淤积消退10例），对照组8例。比较各组的临床和病理形态学特征。肝组织切片行免疫组化染色，对CD3、CD4、CD8、CD20、Foxp3和白细胞介素-17A进行定量分析。采用Kruskal-Wallis检验测量上述指标，采用秩和检验或Fisher确切概率法比较计数资料。Kasai手术后胆道闭锁组的临床和病理胆汁淤积程度明显低于未行Kasai手术组，肝纤维化程度也明显减轻（P<0.05），但两组门静脉区炎症程度差异无统计学意义（P>0.05）。肝内浸润的免疫细胞类型存在统计学差异（P<0.05）。与未行Kasai手术组相比，Kasai手术后组门静脉区CD3、CD8、IL-17A和Foxp3阳性细胞浸润明显减少（P<0.05），但两组Foxp3/CD4阳性细胞比例差异无统计学意义（P>0.05），且持续低于对照组（P<0.05）。与未行Kasai手术组相比，Kasai手术后组门静脉区Foxp3/IL-17A和Foxp3/CD8阳性细胞比例未显著增加（P>0.05），且仍低于对照组。然而，Foxp3/IL-17A和Foxp3/CD8阳性细胞比例显著降低（P<0.05）。Kasai胆道闭锁手术后胆汁淤积消退的患者存在肝内炎性细胞浸润及调节性/效应性T淋巴细胞比例失调，这可能是促进疾病进展的重要因素。
