肝移植术后新发抗核抗体阳性患者临床及病理特点分析  

A clinico-pathological analysis of de novo positive anti-nuclear antibody following liver transplantation

作　　者：胡占东[1] 王政禄[1] 郑卫平[2] 章明放[1] 刘懿和[2] 邓永林[2] 郑虹[2] 沈中阳[2] 

机构地区：[1]天津市第一中心医院病理科,300192 [2]天津市第一中心医院移植外科,300192

出　　处：《中华器官移植杂志》2014年第7期408-412,共5页Chinese Journal of Organ Transplantation

基　　金：国家高技术研究发展计划（2012AA021001）

摘　　要：目的 探讨原位肝移植术后新发抗核抗体（ANA）阳性患者的临床及病理特点.方法 回顾性分析32例肝移植术后新出现ANA阳性患者的临床和病理资料,分析自身免疫性肝炎（AIH）评分、自身抗体、丙氨酸转氨酶（ALT）、碱性磷酸酶（ALP）/ALT、IgG/正常值及移植肝病理学表现之间是否存在相关性.结果 32例患者中,AIH评分＞15分（确诊AIH）、10～15（可能AIH）和＜10分（排除MH）者分别占12.5％（4/32）、40.6％（13/32）和46.9％（15/32）.确诊AIH、可能AIH和排除AIH三组中,ALP/ALT＜ 1.5并且IgG/正常值＞1.5者分别占100.0％（4/4）、15.4％（2/13）和0（0/15）,差异有统计学意义（P=0.000）.32例的病理表现包括中度淋巴细胞性汇管区炎、界面炎、中央静脉周围炎、肝细胞变性坏死、肝窦淋巴细胞浸润、肝组织淤胆和肝细胞玫瑰花环形成等,三组中,中度淋巴细胞性汇管区炎、界面炎及中央静脉周围炎均出现者分别占100.0％（4/4）、46.2％（6/13）和13.3％（2/15）,差异有统计学意义（P=0.003）.抗体滴度、ALT升高幅度、单项病理学改变对AIH评分无影响（P＞0.05）.ALT分别为0～40 U/L、41～100U/L及＞100 U/L者界面炎发生率分别为0（0/2）、60.0％（9/15）和100.0％（15/15）,差异有统计学意义（P=0.001）.结论 依照AIH评分标准对肝移植术后新发自身抗体阳性患者进行判定,大多数不能确诊为AIH.出现ANA阳性时,应结合临床及特异性的病理特点以及AIH评分综合分析判断,应与排斥反应、病毒性肝炎和药物性因素相鉴别.ALP/ALT＜ 1.5并且IgG/正常值＞1.5可作为新发AIH诊断的参考依据.Objective To study the clinicopathological features of de novo anti-nuclear antibody （ANA） positive patients following liver transplantation.Method A retrospective analysis on the clinicopathological data of 32 ANA-positive patients after liver transplantation.The correlation of autoimmune hepatitis （AIH） scores,autoantibodies,alanine aminotransferase （ALT）,alkaline phosphatase（ALP）/ALT ratio,IgG/normal ratio and pathological manifestations was analyzed.Result In 32 patients,the percentage of patients with AIH scores above 15 points （definite AIH）,10 to 15 （possible AIH） and below 10 points （non-AIH） was 12.5％ （4/32）,40.6％ （13/32） and 46.9％ （15/32）,respectively.The percentage of patients with ALP/ALT ratio below 1.5 and IgG/normal ratio above 1.5 was 100.0％ （4/4）,15.4％ （2/13） and 0％ （0/15） respectively in three groups.The was significant difference among three groups （P =0.000）.The percentage of patients with moderate lymphocytic periportal inflammation,interface inflammation and inflammation around the central vein together was 100.0％ （4/4）,49.2％ （6/13） and 13.3％ （2/15） respectively.There was significant difference in pathological characteristics （P =0.003）.No significant correlation was found between AIH score and single antibody titers,the magnitude of elevated ALT,pathological characteristics （P＞0.05）.The incidence rate of patients with ALT below 40 U/L,41 to 100 U/L and above 100 U/L was 0（0/2）,60.0％ （9/15）,and 100.0％ （15/15）,respectively.There was significant difference （P =0.001）.Conclusion In these cases,most patients can not be diagnosed with AIH according to AIH scoring criteria.It should be analyzed and judged with clinical,specifically pathological characteristics and AIH score when ANA expression was positive,to exclude rejection,viral hepatitis and drug-induced factors.ALP/ALT ratio below 1.5 and IgG/normal ratio above 1.5 can be considered as clinical indication of de novo autoimmune

关 键 词：肝移植 抗体 抗核 病理学 临床 并发症 肝炎 自身免疫性 

分 类 号：R657.3[医药卫生—外科学]