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原发性胆汁性胆管炎的病理学诊断

王秋鹏 甘梅富

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原发性胆汁性胆管炎的病理学诊断

DOI: 10.12449/JCH240604
利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:王秋鹏负责撰写修改论文;甘梅富负责拟定写作思路,指导撰写文章并最后定稿。
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    甘梅富, ganmf@enzemed.com (ORCID: 0000-0002-8143-100X)

Pathological diagnosis of primary biliary cholangitis

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    Corresponding author: GAN Meifu, ganmf@enzemed.com (ORCID: 0000-0002-8143-100X)
  • 摘要: 近年来原发性胆汁性胆管炎发病机制、诊断及治疗等方面的研究均取得新的进展。根据患者临床特征及病理学特点准确诊断、评估预后及风险分层对原发性胆汁性胆管炎的治疗具有十分重要的意义。本文就原发性胆汁性胆管炎的临床病理特征及治疗进展做一概述。

     

  • 图  1  PBC Ⅰ期

    注: 汇管区较多淋巴细胞、浆细胞浸润,胆管上皮细胞排列不整,胞浆嗜酸性,肉芽肿形成(HE染色,×20)。

    Figure  1.  Stage 1 PBC

    图  2  PBC Ⅱ期

    注: a,汇管区周边细胆管增生,可见界板性肝炎及炎性纤维间隔(HE染色,×20);b,CK7免疫组化染色显示反应性增生的细胆管(EnVision法,×20)。

    Figure  2.  Stage 2 PBC

    图  3  PBC Ⅲ期

    注: a,汇管区固有小胆管缺失,汇管区及间隔周围界面炎范围扩大,可见桥接性纤维化(HE染色,×20);b,汇管区周边肝细胞内铜颗粒沉积(罗丹宁染色,×40)。

    Figure  3.  Stage 3 PBC

    图  4  PBC Ⅳ期

    注: 汇管区周边肝细胞体积增大,胞质疏松,呈羽毛状变性,形成汇管区-汇管桥接性纤维化(HE染色,×20)。

    Figure  4.  Stage 4 PBC

    图  5  PBC-AIH重叠综合征

    注: 汇管区大量淋巴细胞、浆细胞浸润,中重度界面炎,可见旺炽性胆管病变及肉芽肿(HE染色,×20)。

    Figure  5.  Overlap of AIH with PBC

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    中华医学会肝病学分会. 原发性胆汁性胆管炎的诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38( 1): 35- 41. DOI: 10.3969/j.issn.1001-5256.2022.01.007.
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  • 收稿日期:  2024-03-27
  • 录用日期:  2024-04-23
  • 出版日期:  2024-06-25
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