转氨酶升高的特发性炎性肌病患者肝脏损伤的研究

贺玉凯; 闪海霞; 张帆; 吴爱华; 朱幼芙

转氨酶升高的特发性炎性肌病患者肝脏损伤的研究

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中图分类号: R746.5;R593.26
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出版历程
- 出版日期: 2009-03-20

摘要

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（40120）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...
- 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。
Abstract: 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 40120U/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 obviousCD138 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.
- idiopathic inflammatory myopathy (IIM) /
- Iiver biopsy /
- liver injury /
- CD138 positive plasma cells /
- autoimmune hepatitis (AIH)

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参考文献(20)

[1]叶任高, 内科学[M].第6版.北京:人民卫生出版社, 2004∶929-932.

[2]Williams RM, Myers AM.A new approach to measurin recovery ininjured workers with acute low back pain:Resumption of Activitiesof Daily Living Scale[J].Phys Ther, 1998, 78 (6) ∶613-23.

[3]Atsushi T, Isao T, Takashi K, et al.CD8-positive Tcell-inducedliver damage was found in a patient with polymyositis[J].InternMed, 2006, 45 (18) ∶1059-1063.

[4]Greenberg SA, Bradshaw EM, Pinkus JL, et al.Plasma cells inmuscle in inclusion body myositis and polymyositis[J].Neurology.2005, 65 (11) ∶1782-1787.

[5]Bradshaw EM, Orihuela A, McArdel SL et al.A local antigen-driven humoral response is present in the inflammatorymyopathies[J].Journal of Immunology, 2007, 178 (1) ∶547-556.

[6]Alvarez F, Berg PA, Bianchi FB, et al.International AutoimmuneHepatitis Group Report:review of criteria for diagnosis of autoim-mune Hepatitis[J].J Hepatol, 1999, 31 (5) ∶929-938.

[7]刘芳, 蒲传强.炎症性肌病肌肉功能障碍的研究[J].中国神经免疫学和神经病学杂志, 2006, 13 (1) ∶28-30.

[8]Stein MT, Tipnis NA, Schultz P.Fatigue, Decreased Interest inPlay, Motor Delay, and Elevated Liver Function Tests in a 4-Year-Old Boy[J].J Dev Behav Pediatr, 2004, 25 (5) , 38-42.

[9]陈荷英, 冯藏蕊.误诊为肝炎的进行性肌营养不良症4例[J].实用儿科临床杂志, 2003, 18 (3) ∶215.

[10]Rahul A, Shireen P, Telfer B, et al.Serum Alanine Aminotrans-ferase in Skeletal Muscle Diseases[J].Hepatology, 2005, 41 (2) ∶308-382.

[11]Morse RP, Rosman NP.Diagnosis of occult muscular dystrophy:importance of the chance finding of elevated serum aminotransferaseactivities[J].The journal of pediatrics, 1993, 122 (2) :254-256.

[12]Kojima H, Uemura M, Sakurai S, et al.Clinical features of liverdisturbance in rheumatoid diseases:clinicopathological study withspecial reference to the cause of liver disturbance[J].Gastroenterol, 2002, 37∶617-625.

[13]杨晓军, 邝卫红.神经肌肉疾病的临床诊断思路[J].湖南中医药导报.2004, 10 (7) ∶60-63.

[14]石峻, 王丽娜, 丁秀荣, 等.血清α-HBDH与LDH比值在心肌炎诊断中的临床探讨[J].Chinese Joural of Coal Industry Medi-cine, 2002, 5 (6) ∶634.

[15]钱学贤, 戴玉华, 孔华宇.现代心血管病学[M].北京:人民军医出版社, 1999∶1306.

[16]王丽娜, 宋艳荣, 石峻.羟丁酸脱氢酶/乳酸脱氢酶在心肌损伤与肝脏损伤中的鉴别诊断价值[J].中国综合临床, 2006, 22 (2) ∶128-129.

[17]Dalakas MC, Hohlfeld R.Polymyositis and dermatomyositis[J].Lancet, 2003, 362∶971-982.

[18]Cherin P, Herson S, Crevon MC, et al.Mechanisms of lysis by ac-tivated cytotoxic cells expressing perforin and granzyme-B genesand the protein TIA-1 in muscle biopsies of myositis[J].J Rheu-matol, 1996, 23∶1135-1142.

[19] Hideyuki K, Masahito U, Shinya S, et al.Clinical features of liverdisturbance in rheumatoid diseases:clinicopathological study withspecial reference to the cause of liver disturbance[J].J Gastroen-terol, 2002, 37∶617-625.

[20]Matsumoto T, Kobayashi S, Shimizu H, et al.The liver in collagendiseases:pathologic study of 160 cases with particular reference tohepatic arteritis, primary biliary cirrhosis, autoimmune hepatitis andnodular regenerative hyperplasia of the liver[J].Liver, 2000, 20∶366-373.

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