EpCAM阳性的不成熟胆道上皮细胞促进胆道闭锁肝纤维化的研究  

Induction of liver fibrosis by EpCAM positive immature biliary epithelial cells in biliary atresia

作　　者：曾信豪[1] 林泽锋[1] 张红[1] 张锐忠[1] 周庆和[1] 夏慧敏[1] 钟军[1] 

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心小儿外科,510120

出　　处：《中华小儿外科杂志》2016年第3期201-205,共5页Chinese Journal of Pediatric Surgery

基　　金：广东省省级科技计划项目（2014A020212373,2014A020212023）

摘　　要：目的分析在胆道闭锁患儿肝组织中增生的EpCAM阳性的不成熟胆道上皮细胞与肝纤维化形成的关系，从而探讨不成熟的胆道上皮细胞在胆道闭锁病程进展中的作用。方法选取2012年1月至2015年6月于我院就治的患儿肝石蜡标本进行连续切片，其中胆道闭锁（biliary atresia，BA）65例，胆总管囊肿（choledochal cyst，CC）27例，门静脉海绵样病变（cavernous transforrnation of portalvein，CTPV）15例，应用CK19、EpCAM免疫组织化学染色及饱和苦味酸天狼星红染色方法，分析肝组织中增生的胆道上皮细胞的成熟性、EpCAM阳性的不成熟胆道上皮细胞与肝纤维化在位置上的关系，并应用Image-pro对400倍视野下肝组织切片中EpCAM阳性细胞进行计数，观察其增生数量与肝纤维化分级间的关系。结果在CTPV组可见由CK19阳性的胆道上皮细胞组成的正常成熟的胆管，未见明显增生的胆道上皮细胞。在BA组及有纤维化的CC组可见胆道上皮细胞增生明显，邻近肝纤维化部位的胆道上皮细胞主要为EpCAM阳性的不成熟胆道上皮细胞，与肝纤维化存在位置上的关联。在胆道闭锁肝组织中随着肝纤维化的程度越高，EpCAM阳性的不成熟胆道上皮细胞的数量越多，且不同肝纤维化分期中EpCAM阳性细胞增生的数量存在显著差异（r=0．56，Pd0．001）。结论在小儿胆道闭锁疾病中，EpCAM阳性的不成熟胆道上皮细胞在短时间内迅速增生，可能是胆道闭锁患儿肝纤维化进展迅速的主要原因。Objective To explore the relationship between EpCAM positive immature biliary epithelial cells （BECs） and liver fibrosis in biliary atresia （BA） patients and elucidate the role of immature BECs in BA. Methods Liver samples were collected from January 2012 to June 2015, including BA （n = 65）, choledochal cyst （CC, n = 25） and cavernous transformation of portal vein （CTPV, n = 15）. Immunohistochemical staining of CK19, EpCAM and saturated picric acid sirius red staining were performed for BEC maturation and liver fibrosis. Imaging and statistical software were used for positive cell counting and statistical analyses. Results In CTPV group, the morpohology of bile ducts was basically normal and CK19 positivity indicated mature BECs. No hyperplasia was found in BECs. And proliferative BECs were found in BA and CC with liver fibrosis. The BECs adjacent to liver fibrosis area were predominantly EpCAM positive immature BECs. Furthermore, statistically significant correlation was observed between EpCAM positive immature BECs and degree of liver fibrosis in BA （r = 0. 56, P〈0. 001）. Conclusions The proliferation of EpCAM positive immature BECs may be primarily responsible for rapidly progressive fibrosis in BA.

关 键 词：胆道闭锁 肝硬化 免疫组织化学 

分 类 号：R725.7[医药卫生—儿科]