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贝德灵顿梗犬遗传性、慢性、进行性肝变性伴肝脏铜浓度升高:临床和病理观察以及与其他铜相关肝病的比较

Inherited, chronic, progressive hepatic degeneration in Bedlington terriers with increased liver copper concentrations: clinical and pathologic observations and comparison with other copper-associated liver diseases.

作者信息

Hultgren B D, Stevens J B, Hardy R M

出版信息

Am J Vet Res. 1986 Feb;47(2):365-77.

PMID:3954222
Abstract

One hundred nineteen hepatic tissue samples from 117 Bedlington Terriers were divided into 6 groups depending on the severity of histopathologic hepatic changes. Group 0 comprised dogs with microscopically normal livers. Group I dogs had copper-positive, lipofuscin-containing lysosomes present in centrilobular hepatocytes. Microfoci of hepatic necrosis, in addition to the increased numbers of the copper-positive, lipofuscin-containing lysosomes in centrilobular and periportal hepatocytes, were present in group II dogs. Group III dogs had more copper-positive, lipofuscin-containing lysosomes present translobularly and morphologic changes consistent with chronic active hepatitis. Mixed micro- or macronodular cirrhosis and translobular presence of copper-positive, lipofuscin-containing lysosomes characterized group IV dogs. Dogs in group V had massive hepatic necrosis and morphologic changes that were consistent with the changes in group III and IV dogs. Histochemical staining for copper was useful in making the microscopic diagnosis of this disease and was shown to be necessary in early diagnosis (group I) when other clinical and pathologic values associated with this syndrome were not consistently abnormal. Copper histochemical stains varied in sensitivity. Timm's silver sulfide was more sensitive for copper than was rubeanic acid, which was more sensitive than rhodanine staining. The brown pigment associated with the copper in the lysosomes was shown to be lipofuscin pigment with the aid of histochemical staining with orcein, Prussian blue, periodic acid-Schiff, and acid-fast stains together with fluorescent microscopy (excitation maxima: 365 nm; emissions: 420 + nm). Since these were positive only in later stages of the hepatic disease, they were not especially useful in its early diagnosis. The severity of the histopathologic hepatic changes was shown to increase with age and was associated with increasing hepatic copper concentration. These observations illustrate that this inherited, chronic hepatic degeneration in the Bedlington Terrier is progressive. Clinical chemical tests were diagnostically useful only in later stages of the disease. Alanine transaminase activity was of most value, but was not always abnormal, even when severe hepatic damage was present. Clinical signs of hepatic disease were seen in dogs in groups III, IV, and V. Death due to hepatic failure occurred only in dogs in groups III, IV, and V. Hemosiderin was present in increased amounts in the liver, bone marrow, spleen, and lymph nodes of affected Bedlington Terriers, indicating that a possible defect in iron metabolism and/or an increase in RBC turnover existed.(ABSTRACT TRUNCATED AT 400 WORDS)

摘要

从117只贝林登梗犬身上获取的119份肝组织样本,根据肝组织病理变化的严重程度分为6组。0组包括肝脏显微镜检查正常的犬只。I组犬的中央小叶肝细胞中存在含铜阳性、含脂褐素的溶酶体。II组犬除中央小叶和汇管区肝细胞中含铜阳性、含脂褐素的溶酶体数量增加外,还出现了肝坏死微灶。III组犬肝小叶内有更多含铜阳性、含脂褐素的溶酶体,且有与慢性活动性肝炎一致的形态学改变。IV组犬的特征为混合性小结节或大结节性肝硬化以及肝小叶内存在含铜阳性、含脂褐素的溶酶体。V组犬出现大片肝坏死,其形态学改变与III组和IV组犬一致。铜的组织化学染色有助于对该病进行显微镜诊断,且在早期诊断(I组)中显示是必要的,此时与该综合征相关的其他临床和病理指标并非始终异常。铜组织化学染色的敏感性各不相同。硫化银Timm法对铜的敏感性高于赤藓酸,赤藓酸又比罗丹宁染色更敏感。借助于orcein、普鲁士蓝、过碘酸-希夫染色和抗酸染色以及荧光显微镜检查(激发最大值:365nm;发射:420+nm),溶酶体中与铜相关的棕色色素被证明是脂褐素色素。由于这些仅在肝病后期呈阳性,因此对早期诊断并非特别有用。肝组织病理变化的严重程度随年龄增加而加重,且与肝脏铜浓度升高有关。这些观察结果表明,贝林登梗犬的这种遗传性慢性肝变性是进行性的。临床化学检测仅在疾病后期具有诊断价值。丙氨酸转氨酶活性最有价值,但即使存在严重肝损伤时也并非总是异常。III组、IV组和V组的犬出现了肝病的临床症状。仅III组、IV组和V组的犬因肝衰竭死亡。患病贝林登梗犬的肝脏、骨髓、脾脏和淋巴结中含铁血黄素含量增加,表明可能存在铁代谢缺陷和/或红细胞周转率增加。(摘要截选至400字)

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