转氨酶升高的特发性炎性肌病患者肝脏损伤的研究  

The study of liver injury in Idiopathic inflammatory myopathy patients with hyperaminotransferase.

作　　者：贺玉凯[1] 闪海霞[1] 张帆[1] 吴爱华[1] 朱幼芙[1] 

机构地区：[1]南方医科大学附属南方医院感染内科,广东广州510515

出　　处：《临床肝胆病杂志》2009年第3期194-198,共5页Journal of Clinical Hepatology

摘　　要：目的探讨转氨酶升高的特发性炎性肌病（Idiopathic Inflammatory Myopathy,IIM）患者肝脏损伤情况及血清ALT来源;观察IIM患者与自身免疫性肝炎（autoimmune hepatitis,AIH）患者肝组织中CD138^＋浆细胞浸润情况。方法分析28例IIM患者临床及血清学资料,并对其中6例IIM患者及另外11例AIH患者行肝活检（HE常规染色和免疫组化特异性染色）。结果IIM患者血清ALT均值（198.8±209.0）U/L,50%（14/28）的患者血清ALT轻度升高,在（40-120）U/L之间,与AIH患者无明显差异（P〉0.05）,与健康人有显著性差异（P〈0.01）;乳酸脱氢酶（LDH）和羟丁酸脱氢酶（HBDH）异常率为100%和85.7%,显著高于肌酸激酶（CK）的78.6%;组织学检查：IIM患者肝组织损伤轻微,肝窦内和汇管区有少至中量炎症细胞浸润,未发现明显CD138^＋浆细胞浸润;而AIH患者肝组织损伤较重,汇管区有大量炎症细胞浸润并向周围肝实质扩散,汇管区有明显CD138^＋浆细胞浸润。结论转氨酶升高的IIM患者肝组织损伤轻微,血清ALT升高除来源于损伤肝组织外,还由肌肉等组织损伤共同引起,体液免疫在IIM相关肝损伤机制中可能未起重要作用。Objective To investigate liver damage and the source of serum ALT in Idiopathic Inflammatory Myopathy（IIM） patients with hyperaminotransferase and observe the infiltrating CD138 positive plasma cells in liver tissue of IIM and autoimmune hepatitis patients. Methods Clinical and serologic data of 28 IIM patients was analyzed. The liver biopsy was carried out in 6 IIM patients and 11 AIH patients by HE staining and immunohistochemistry. Results The mean of serum ALT level is 198. 8 ± 209.0U/L in IIM patients and ALT elevated gently between 40 - 120U/L in 50% （14/28）. Compare with AIH patients, there was no significant difference （ P 〉 0. 05 ）, Inversely, compare with the healthy controls, notable diference was be founding （P 〈 0. 01 ）, The abnormal rate of Lactate Dehydrogenase （LDH） and Hydroxybutyrate Dehydrogenase （HBDH） are 100% and 85. 7%, higher than 78.6% of the Creatinkinase （CK）, Should that, liver damage was mild and a few to middle quantity inflammatory cells infiltrated in portal tract In the PM patients, in which no obvious CD138 positive plasma cells were found In AIH patients, liver damage was appreciably heavily, massive inflammatory cells infiltrated in portal tract and further extend to the surrounding liver parenchyma, and manifest infiltration of CD138 positive plasma cells were detected in portal tract. Conclusion Conclusion Slight liver damage was found in IIM patients, whose elevated ALT excluding from injury liver,the impair muscle may be another source. Humoral immunity may dosen＇t play a key role in IIM correlated hepatic injury.

关 键 词：特发性炎性肌病 肝活检 肝脏损伤 CD138^+浆细胞 自身免疫性肝炎. 

分 类 号：R746.5[医药卫生—神经病学与精神病学] R593.26[医药卫生—临床医学]