非酒精性脂肪肝及其合并亚临床型乙肝病毒感染的病理和免疫研究

摘要

Objective The aim of this study was to explore the pathologic and immunologic change in non-alcoholic fatty liver disease(NAFI.D) with or without subclinical hepatitis B virus infection. Methods 47 patients were divided into two groups:group A:33 patients with NAFLD;group B:14 patients with NAFLD and subclinical hepatitis B virus infection. All the subjects diagnosed by liver biopsy, the degree of steatosis, inflammation, fibrosis and the expression of lgA, IgM, IgG, C3d, C3 c,C1 q, CD 20, CD 45 RO in liver tissue were observed. Results There was no significant correlation between the degree of steatosis, inflammation, fibrosis ( P ＞ 0.05 ). The expression of lgA, IgM, lgG, C3 d, C3c, C1 q, CD 20, CD 45RO in liver tissue had no significantly differences between the two groups ( P ＞ O. 05 ) . The deposition of lgA, lgM, lgG in liver tissue was observed. The teatosis degree of the livers was positively related to the deposition of lgA, IgM, lgG in liver tissue (P ＜ 0. O1 ). The expression of C3d, C3c, CIq, CD 20, CD 45RO was not significantly related to the .degree of steatosis, inflammation and fibrosis ( P ＞ 0.05 ).Conclusion The deposition of lgA,IgM, lgG in liver tissue was significantly related to the degree of steatosis. The underlying mechanism was unclear. These suggest that subclinical hepatitis B virus infection has no clinical or pathologic influence on NAFLD.%目的 探讨非酒精性脂肪肝(NAFLD)与NAFLD合并亚临床型乙肝病毒感染的病理与免疫特征.方法 选取2007年6月至2009年12月南京军区福州总医院门诊及住院NAFLD及NAFLD合并亚临床型乙肝病毒感染患者共47例,其中NAFLD组(A组)33例,NAFLD合并亚临床型乙肝病毒感染组(B组)14例.所有病例均行肝穿刺活检术.肝穿标本分别行HE、二步法免疫组化IgA、IgM、IgG、C3d、C3c、C1q和CD 20、CD 45RO染色.所有标本均做HBsAg染色.光学显微镜下观察肝组织脂肪变程度、炎症程度、纤维化程度及各种免疫沉积物在肝组织中的阳性表达.将两组间指标及所有病例病理与免疫指标之间的关系进行比较.结果 NAFLD组(A组)33例,男29例,女4例;NAFLD合并亚临床型乙肝病毒感染组(B组)14例,男11例,女3例.A组和B组之间肝脂肪变程度(F)、炎症分级(G)和纤维化分期(S)之间无统计学差异且F、G、S之间无明显相关性(P均>0.05).A组与B组间IgA、IgM、IgG、C3d、C3c、C1q、CD 20、CD 45RO染色在组织中的表达无统计学差异(P均＞0.05).IgA、lgM、IgG在肝组织的表达程度与肝组织脂肪变程度呈正相关(P均<0.01),而C3d、C3c、C1q、CD 20、CD 45RO在肝组织中的表达与F、G、S均无相关性(P均＞0.05).结论 NAFLD患者肝组织未见免疫紊乱证据,但IgA、lgM、IgG在肝组织中呈弥漫性表达,且表达程度与肝组织脂肪变程度呈正相关,原因有待进一步研究.合并亚临床型乙肝病毒感染并不会对NAFLD的临床指标及组织学损伤程度产生影响.