移植肝中央静脉周围炎型排斥反应:4例报道及文献复习  

Central perivenulitis rejection on liver allograft:4 cases report and literature review

作　　者：宋晨朝[1] 常静[1] 曾道炳[2] 栗光明 王欣欣[1] SONG Chenchao;CHANG Jing;ZENG Dao-bing;LI Guang-ming;WANG Xin-xin(Department of Pathology,Beijing You’an Hospital,Capital Medical University,Beijng100069,China;Department of Surgery,Beijing You’an Hospital,Capital Medical University,Beijng100069,China)

机构地区：[1]首都医科大学附属北京佑安医院病理科,北京100069 [2]首都医科大学附属北京佑安医院外科,北京100069

出　　处：《诊断病理学杂志》2023年第2期110-114,共5页Chinese Journal of Diagnostic Pathology

基　　金：北京市医院管理中心重点医学专业发展计划(ZYLX202124)

摘　　要：目的观察和总结移植肝中央静脉周围炎型排斥反应的临床和组织病理学特点,并结合文献复习进一步明确其临床病理学意义。方法回顾性分析4例肝移植受者(移植后均称为“受者”)的5次移植肝穿刺活检组织标本,并收集其临床资料、实验室检查和随访数据。所有标本均经HE染色、Masson三色染色、Gordon-Sweets网状纤维染色和D-PAS染色的特殊染色;同时进行了包括HBsAg、HBcAg、CK7、MUM1、IgG4、CD3、CD20、CD4、CD8和C4d在内的多种免疫组织化学染色。结果4例受者原发病分别为酒精性脂肪性肝硬化(n=1),肝细胞癌合并肝豆状核变性(n=1),原发性胆汁性胆管炎肝硬化(n=1),慢性乙型病毒性肝炎肝硬化(n=1)。所有受者移植肝活检组织中均观察到肝小叶中央静脉周围肝细胞的急性坏死,1例单纯中央静脉周围炎型的受者发病早于其它3例伴汇管区排斥的受者。免疫组化上,浸润炎细胞主要为CD8+T淋巴细胞和MUM1+浆细胞,C4d染色呈无或低表达。4例受者确诊后均接受了增加免疫抑制剂剂量和类固醇激素冲击治疗,治愈1例,好转1例,复发1例,死亡1例。结论中央静脉周围炎型排斥反应是CD8+T细胞介导的细胞免疫为主的排斥反应,且可能与排斥反应复发有关,需要临床更积极的治疗。术前机体免疫状态与中央静脉周围炎型急性排斥反应发生有关。Objective To observe and summarize the clinical and histolopathological features of central perivenulitis rejection on liver allograft,and to clarify its significance based on literatures.Methods The histological features of 5 liver allograft biopsies in 4 recipients were reviewed,and the clinical data,laboratory examination and follow-up data were collected.All specimens were stained with special chemical staining:Masson trichrome staining,Gordon-Sweets reticular fiber staining and D-PAS staining,and immunohistochemical staining of multiple antibodies agents,including:HBsAg,HBcAg,CK7,MUM1,IgG4,CD3,CD20,CD4,CD8 and C4d.Results The primary diseases of the 4 recipients were alcoholic fatty liver disease with cirrhosis(n=1),hepatocellular carcinoma with Wilson disease(n=1),Primary biliary cholangitis with cirrhosis(n=1)and hepatitis B virus related cirrhosis(n=1).Acute necrosis of hepatocytes in the central perivenous was observed in all liver biopsies.One recipient with pure central perivenulitis rejection had an earlier onset than the other three patients with portal rejection.Immunohistochemical staining showed the infiltrating inflammatory cells were mainly CD8+T lymphocytes and MUM1+plasma cells,C4d wereno or low expression.After diagnosis,4 recipients were treated with increased dose of immunosuppressants and steroids pulse therapy.1 case was cured,1 case improved,1 case relapsed and 1 case died.Conclusion Central perivenulitis rejection is mainly cellular immunity mediated by CD8+T cells,and is related to the recurrence of rejection,which requires more active clinical treatment.The preoperative immune status of recipient is related to the occurrence of central perivenulitis rejection.

关 键 词：肝移植 组织病理学 排斥反应 中央区静脉周围炎 

分 类 号：R602[医药卫生—外科学]