HISTOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF THE GALL-BLADDER LESION IN PRIMARY SCLEROSING CHOLANGITIS
HISTOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF THE GALL-BLADDER LESION IN PRIMARY SCLEROSING CHOLANGITIS
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DOI：
10.1136/gut.32.4.424
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发表时间：
1991-04-01
期刊：
影响因子：
24.5
通讯作者：
SHILKIN, KB
中科院分区：
文献类型：
--
作者：
JEFFREY, GP;REED, WD;SHILKIN, KB
应用常规染色和免疫组织化学方法对6例原发性硬化性胆管炎患者的胆囊单核细胞浸润的组织学特征和类型进行了研究。6名慢性胆囊炎患者和4名原发性胆汁性肝硬变患者(年龄和性别匹配)的胆囊壁进行对照研究。原发性硬化性胆管炎患者的胆囊壁存在一系列的组织学异常，包括轻度到中度的上皮细胞增生、假性颗粒形成和单个核细胞的上皮浸润；中度到重度的慢性炎症细胞浸润性和纤维化影响到胆囊壁的浅层和深层；以及轻微的平滑肌肥大。这些异常是非特异性的，也存在于慢性胆囊炎和原发性胆汁性肝硬变患者的胆囊壁中。原发性硬化性胆管炎患者无血管炎和肉芽肿。免疫组织化学结果显示，原发性硬化性胆囊炎的浅表和深层单个核细胞浸润物主要由淋巴细胞组成，而慢性胆囊炎的巨噬细胞数量相当或更多。此外，在慢性胆囊炎胆囊炎的胆囊壁中，T淋巴细胞(活化的和静止的)分布于整个淋巴细胞层，与胆管上皮细胞相对，并在胆管上皮细胞之间交错排列，数量明显多于慢性胆囊炎。B淋巴细胞仅见于淋巴滤泡。使用三名原发性硬化性胆管炎患者的肝活检标本进行的对比研究显示，有相似的T淋巴细胞汇管区浸润性病变。我们的结论是，在原发性硬化性胆管炎的胆囊中存在许多非特异性的慢性炎性组织学异常。免疫组织化学发现该病的其他特征--以淋巴细胞为主的单个核细胞在胆囊壁的浅层和深层浸润性，以及T淋巴细胞的存在，浸润性胆管上皮细胞。这些发现支持细胞免疫机制异常在原发性硬化性胆管炎肝内和肝外病变的发病机制中的作用的假说。
The histological features and type of mononuclear cell infiltrate in gall bladders from six patients with primary sclerosing cholangitis were studied using routine staining techniques and immunohistochemistry. Control studies were performed using the gall bladders from six patients (age and sex matched) with chronic cholecystitis and four with primary biliary cirrhosis. A range of histological abnormalities was present in gall bladders from patients with primary sclerosing cholangitis including a mild to moderate degree of epithelial hyperplasia, pseudogland formation, and mononuclear cell infiltrate of the epithelium; moderate to severe chronic inflammatory cell infiltrate and fibrosis affecting the superficial and deep layers of the gall bladder wall; and minimal smooth muscle hypertrophy. These abnormalities were nonspecific and were also present in gall bladders from patients with chronic cholecystitis and primary biliary cirrhosis. Vasculitis and granulomas were not present in the patients with primary sclerosing cholangitis. Immunohistochemistry showed that the superficial and deep mononuclear cell infiltrate in primary sclerosing cholangitis gall bladders was composed predominantly of lymphocytes, in contrast to chronic cholecystitis where macrophages were found in similar or greater numbers. Moreover, T lymphocytes (activated and resting) were present throughout the lymphocytic infiltrate and were apposed to the base and interdigitated between the biliary epithelial cells in significantly greater numbers than in chronic cholecystitis gall bladders. B lymphocytes were present only in lymphoid follicles. Comparative studies using liver biopsy specimens from three of the primary sclerosing cholangitis patients showed a similar T lymphocyte portal tract infiltrate. We conclude that a number of non-specific chronic inflammatory histological abnormalities were present in primary sclerosing cholangitis gall bladders. Immunohistochemistry found other features that were present in this disease - a predominantly lymphocytic mononuclear cell infiltrate of the superficial and deep layers of the gall bladder wall and the presence of T lymphocytes that infiltrated the biliary epithelial cells. These findings support the hypothesis that aberrant cell mediated immune mechanisms may play a role in the pathogenesis of both the intrahepatic and extrahepatic lesions in primary sclerosing cholangitis.