肝包虫周围纤维囊壁中骨桥蛋白免疫印记与组化分析

目的:研究肝细粒棘球蚴(肝包虫)周围纤维囊壁中骨桥蛋白(osteopontin,OPN)的表达定位．方法:采用免疫印记法检测OPN在肝细粒棘球蚴(n=48)周围纤维囊壁中的表达,并结合免疫组化方法观察其组织学分布．结果:肝细粒棘球蚴周围纤维囊壁经免疫印记分析80％有OPN表达,形态学观察集中分布于近虫体侧纤维性囊壁(内层),与近肝侧纤维性囊壁(外层)比较有显著差异(75％ vs 8．3％, P<0．05)．结论:OPN参与肝细粒棘球蚴周围内层纤维性囊壁肉芽肿反应的调节．     

骨桥蛋白在肝细粒棘球蚴外囊壁中的表达

目的 研究骨桥蛋白（osteopontin，OPN）在肝细粒棘球蚴外囊壁中的分布及表达。 方法 用免疫组化、免疫荧光双标记法观察60例患者手术切除的肝细粒棘球蚴外囊壁及巨噬细胞中OPN的表达与分布；Von Kossa染色观察囊壁中钙化分布特征。 结果 肝细粒棘球蚴外囊壁中有不同程度OPN表达，75%（45/60）集中分布于近虫体侧纤维囊壁（内层），.3%（5/60）分布于近肝组织侧纤维性囊壁（外层），两者差异有统计学意义（P＜0.01）。在内、外层交界处可见巨噬细胞带，多数巨噬细胞胞浆内有OPN表达。OPN表达阳性的囊壁均合并有不同程度的钙盐沉积，其在囊壁内、外层的分布与OPN的基本一致。 结论 OPN主要分布在肝细粒棘球蚴外囊的内层纤维囊壁。     

肝细粒棘球蚴外囊壁钙化相关受体

目的 比较肝细粒棘球蚴病患者钙化外囊壁及非钙化外囊壁上的钙化相关受体BMPRⅡ(骨形态发生蛋白Ⅱ型受体)、IGF1R(胰岛素样生长因子1受体)和ERα(雌激素受体α)的表达差异。方法 钙化外囊壁和非钙化外囊壁茜素红染色,Envision免疫组化法和qRT-PCR分别检测同一细粒棘球蚴病患者钙化外囊壁及非钙化外囊壁上钙化相关受体BMPRⅡ、IGF1R和ERα的表达水平和钙化相关受体的mRNA表达量。结果 与细粒棘球蚴非钙化外囊壁相比较,同一患者钙化外囊壁茜素红染色钙化显著,且差异有统计学意义(χ²=20.369,P<0.01);钙化外囊壁相关受体的表达明显增加,且差异有统计学意义(P<0.05),mRNA表达量明显增高且差异具有统计学意义(P<0.05)。结论 肝细粒棘球蚴病患者钙化外囊壁钙化相关受体表达量较高,钙化相关因子通过与受体BMPRⅡ、IGF1R和ERα等结合,引起细粒棘球蚴外囊壁钙化,外囊壁的钙化可以有效地抑制细粒棘球蚴的生长,在细粒棘球蚴病患者临床治疗过程中发挥着重要作用。     

肝脾棘球蚴囊周围纤维性囊壁形成机制的差异及临床意义

目的　探讨肝、脾棘球蚴囊周围纤维性囊壁的不同形成机制。　方法　苏木素 伊红染色 ,观察 40例肝棘球蚴囊、15例脾棘球蚴囊周围纤维囊壁及其邻近肝、脾实质病理组织学改变。免疫组织化学方法检测Ⅳ型胶原、纤维连接蛋白 (FN)、层粘连蛋白 (LN) ;原位杂交方法检测转化生长因子-β1(TGF-β1)及肿瘤坏死因子-α (TNF-α)的mRNA在肝、脾棘球蚴囊周围纤维囊壁及其邻近肝、脾实质中的表达。　结果　肝棘球蚴囊周围纤维囊壁分两层 ,虫体侧纤维囊壁为肉芽肿样组织 ,肝实质侧纤维囊壁内可见大量受挤压的门静脉、肝动脉和肝管系统 (Glisson)和肝静脉系统 ,并与Glisson鞘相延续。Ⅳ型胶原、FN、LN、TGF-β1及TNF-α在两层中的表达差异均有显著性意义 (P均 <0.01)。脾棘球蚴囊周围纤维囊壁不分层 ,为肉芽肿样组织 ,Ⅳ型胶原、FN、LN、TGF-β1及TNF-α无特异分层表达。 　结论　肝、脾棘球蚴囊周围纤维囊壁的形成机制不同。肝棘球蚴囊周围纤维性囊壁是人体形成肉芽肿样病理改变后被周围受挤压的Glisson系统和肝静脉系统包裹 ,过度肝纤维化所致 ,肉芽肿样组织与周围纤维化的Glisson系统和肝静脉系统间有可分离间隙。脾棘球蚴囊周围纤维性囊壁是肉芽肿样组织包裹虫体形成 ,其与脾实质间无可分离间隙     

肝细粒棘球蚴周围纤维囊壁分层研究现状简介

肝包虫病是新疆地区常见的地方性流行性疾病。临床实践、病理组织学观察以及免疫组化等实验证实,肝细粒棘球蚴周围纤维囊壁可分为内外两层——近肝侧的"外膜"层,与近虫体侧的"外囊"层,且两层的形成机制有所不同。     

手术治疗钙化型肝细粒棘球蚴病的效果观察

目的探讨手术治疗钙化型肝细粒棘球蚴病的临床效果。方法回顾性分析2015年11月-2019年2月于石河子大学医学院第一附属医院行手术治疗(外囊完整剥除术、外囊次全切除术及内囊摘除术)的16例共20个钙化型肝细粒棘球蚴囊肿的临床特点及治疗效果。结果 1例患者行外囊完整剥除术,5例患者行内囊摘除术,10例患者行外囊次全切除术。除1例患者因术前囊肿已破入胆道且外囊壁已存在胆瘘而于术后发生胆漏之外,其余患者术后均未发现残腔积液、感染等残腔并发症及胆漏、黄疸。术后均无死亡、复发病例。结论对于非静止期的钙化型肝细粒棘球蚴病必须手术治疗,外囊完整剥除术并不适用,可优先选用外囊次全切除术,尤其是当出现钙化型肝细粒棘球蚴囊肿邻近肝门部、邻近肝内外大血管及外膜与外囊之间的潜在性腔隙不明显时。而当出现肝细粒棘球蚴囊肿破裂时,可酌情选择内囊摘除术。     

新疆北部双峰驼细粒棘球蚴感染调查

目的：确定我国双峰驼中细粒球蚴的感染状况和寄生特征。方法：在屠宰场检查来自新疆北部各地骆驼体内的感染情况。测量棘球蚴囊的大小，检查内容物的性质并镜检有无原头节。结果：在３７５只骆驼中检出细粒棘球蚴感染者１８５只，感染率４９．３％。主要寄生在肝和肺，肝内较多，肝∶肺＝１∶０．６４。育囊携带率３４．８％，育囊率３９．２％， 囊指数７．５３。棘球蚴囊位于肝表面，单个存在，囊壁较薄，内无子囊。育囊平均直径在肝为５．６±２．５６ｃｍ，在肺为４．８±２．０３ｃｍ，钙化率高，单纯携带钙化病灶的骆驼占感染骆驼的６４．３％。结论：新疆北部双峰驼细粒棘球蚴的感染率很高。其寄生特征与本地区牛、羊中的细粒棘球蚴有明显区别，与非洲单峰驼亦有不同，应进一步深入研究。     

79例肝棘球蚴病患者影像学分析

目的 回顾性分析79例肝棘球蚴病患者的影像学表现,为该病诊断与鉴别诊断提供参考。方法 收集2014-2017年在青海省人民医院行影像学检查并经病理检查证实的79例肝棘球蚴病患者病历资料,对其影像学表现进行回顾性分析。结果 79例肝棘球蚴病患者中,细粒棘球蚴病57例,多房棘球蚴病22例;细粒棘球蚴病患者中,单囊型21例,多子囊型16例,内囊塌陷型9例,实变型4例,钙化型7例。79例患者中,62例为常见影像学征象。单囊型细粒棘球蚴病表现为肝内囊性水样病灶,囊壁薄厚均匀、无强化;多子囊型表现为“囊中囊”、“玫瑰花瓣”、“轮辐征”等;当内囊塌陷分离时表现为“飘带征”、“双环征”等征象;囊壁钙化时呈弧线状、蛋壳状,囊内容物呈现絮状或者整个病灶钙化。多房棘球蚴病表现为肝内实性肿块,密度及信号不均匀,边缘不规则;病灶强化不明显,病灶内散在或者群簇状分布的“小囊泡”,常伴有钙化,整个病灶呈“地图样”外观。另外17例患者表现为复杂少见的影像征象;其中6例细粒棘球蚴病囊内含脂肪,影像表现为囊内单发或多发脂肪密度结节灶,CT值为-28～-84 HU;4例病灶破入胆管,邻近胆管密度增高,胆管壁增厚,周围胆管扩张;4例合并原发性肝癌,影像表现为肝内细粒或多房棘球蚴病合并实性强化肿块,增强呈“快进快出”表现;3例合并感染,影像学表现为囊壁明显增厚且强化明显,其中2例囊内见气体影,1例囊肿合并感染并侵及腹壁。结论 肝棘球蚴病影像学表现复杂多样,在临床工作中需认真分析,做好鉴别诊断。     

小鼠肝细粒棘球蚴和多房棘球蚴病不同时期病灶周围组织纤维化对比

目的 本实验通过研究对比不同时间两种肝棘球蚴病灶周围组织纤维化情况,进一步了解肝棘球蚴病的病理生理发展过程,为肝棘球蚴病的诊治提供参考。方法 建立动物模型,使用HE,Masson染色以及COL1,COL3、α-SMA、TGF-β1免疫组化染色对比观察两种肝棘球蚴病在不同时间纤维化情况的不同。结果 随着时间的变化肝细粒棘球蚴病灶周围纤维化由弥漫到聚集,可形成连续致密的纤维外膜;肝多房棘球蚴病灶周围组织纤维化始终为弥漫性,无法形成连续质密的纤维外膜。细粒棘球蚴组病灶周围COL1(r=-0.768,P<0.05)、COL3(r=-0.781,P<0.05)、α-SMA(r=-0.867,P<0.05)、TGF-β1(r=-0.854,P<0.05)的表达强度与时间呈负相关,多房棘球蚴组病灶周围COL1(r=-0.349,P>0.05)、COL3(r=-0.037,P>0.05)、α-SMA(r=-0.107,P>0.05)、TGF-β1(r=-0.148,P>0.05)的表达强度与时间无相关性。 无相关性同时观察到两种包虫周围细胞外基质胶原含量不同,细粒棘球蚴组I、III型胶原比高于多房棘球蚴组(Z=-3.23,P<0.05)。结论 相较于多房棘球蚴,细粒棘球蚴病灶周围可产生连续致密的纤维外囊。细粒棘球蚴在外囊形成后纤维化进程减弱或停止,多房棘球蚴在整个病程中均有活跃的纤维化反应。细粒棘球蚴相较于多房棘球蚴外囊的I/III型胶原比值较高。     

高强度聚焦超声辐照后细粒棘球蚴囊壁的病理变化

目的 观察细粒棘球蚴囊壁在高强度聚焦超声（HIFU）辐照后的病理改变。方法 采集感染细粒棘球蚴的新鲜羊肝，选取囊壁较薄、触摸弹性较好的细粒棘球蚴30个。采用随机抽样方法等分为3组，每组10个包囊。对照组，用普通诊断超声照射2 min。处理组1和处理组2分别用150 W和250 W声功率对细粒棘球蚴包囊进行沿囊壁多层面的环形扫描，层面间距为5 mm，扫描速度为3 mm/s，照射时间2～10 min（根据包囊大小）。取出照射后先肉眼观察细粒棘球蚴包囊大体改变，后取囊壁组织分别制作病理切片和透射电镜切片，观察其病理改变。 结果 HIFU（250 W）辐照后，细粒棘球蚴包囊剪开处内囊壁立即发生卷曲，剥离出的内囊颜色变白、变硬、透光度降低。病理切片显示，HIFU辐照后细粒棘球蚴的内囊壁上角皮层与生发层大部分发生分离。电镜观察结果显示，HIFU辐照后细粒棘球蚴的角皮层纤维纹理明显改变，生发层细胞发生裂解性破坏。 结论 HIFU沿细粒棘球蚴囊壁的多层面的环形照射可明显损害细粒棘球蚴囊壁。     

Ⅰ、Ⅲ、Ⅳ型胶原在肝包虫囊肿周围人体纤维囊壁中的特异性分层表达

探讨Ⅰ、Ⅲ和Ⅳ型胶原在形成肝包虫囊肿周围人体纤维囊壁中的作用及其临床意义。采用免疫组织化学方法检测Ⅰ、Ⅲ和Ⅳ型胶原在40例肝包虫囊肿周围纤维囊壁中表达。Ⅰ、Ⅲ和Ⅳ型胶原在肝包虫囊肿周围纤维囊壁中出现特异性分层表达。靠近虫体侧纤维囊壁中,Ⅰ、Ⅲ和Ⅳ型胶原的表达阳性率分别为500%、375%和400%。靠近肝实质侧纤维囊壁中,Ⅰ、Ⅲ和Ⅳ型胶原的表达阳性率分别为875%、825%和850%。Ⅰ、Ⅲ、Ⅳ型胶原在两层中表达的差异均有显著意义(P<001,P<001,P<001)。肝包虫囊肿周围人体纤维囊壁分层,Ⅰ、Ⅲ和Ⅳ型胶原与肝实质侧纤维囊壁的形成有密切关系。     

α-SMA在肝包虫囊肿周围组织中的表达

摘要：目的 探讨α-平滑肌肌动蛋白（α-smooth muscle actin;α-SMA）在肝包虫囊肿周围组织中的表达及与肝包虫囊肿的病理过程的关系。方法 采用免疫组化的方法检测α-平滑肌肌动蛋白在50例肝包虫囊肿中的表达。结果 在肝包虫囊肿外膜及周围肝组织中α-平滑肌肌动蛋白出现阳性表达。结论 α-平滑肌肌动蛋白在肝包虫囊肿的病理生长过程中起着重要作用。     

Detection of Osteopontin in the pericyst of human hepatic Echinococcus granulosus

It aims at investigating the expression and distribution of the Osteopontin (OPN) in the pericyst of human hepatic Echinococcus granulosus and their related significances. Sixty pericysts excised by “sub-adventitial cystectomy” were studied. OPN was detected in 80% (48/60) of cysts by Western blotting and distributed in the side of “exocyst” layer directing to the parasite, also macrophages were identified in the vicinity of OPN by immunohistochemistry staining. The coexpression of OPN and CD68 was observed by immunofluorescence double labeling and analyzed by Image-Pro Plus 5.1; with special stain techniques, variable degrees of calcium deposits were observed in 80% (48/60) cysts, and the calcium deposits concurrencely found with the OPN expression. The selective distribution of OPN, calcium in the “exocyst” provides a new pathological evidence for the “sub-adventitial cystectomy” we developed. The pericyst of hepatic E. granulosus consists of two detachable layers with different formative mechanisms: the “exocyst” layer directing towards the cyst of parasite was the result of granulomatous reaction; also the results suggest OPN is one regulator in the granulomatous reaction and calcification of “exocyst”.     

Pericyst: The outermost layer of hydatid cyst

Hydatid disease,caused by the parasite Echinococcus granulosus,mostly affects the liver and the lungs with hydatid cysts which consist of three layers:(1)the outer pericyst;(2)the middle laminated membrane;and(3)the inner germinal layer.Pericyst,as the outermost layer of the hydatid cyst,is made by host cells encasing the hydatid cyst.An extremely close interaction exists between this host tissue and the parasite,and any degenerative changes of the pericyst would result in hydatid cyst degeneration or rupture.The pericyst plays an undeniably important role in the development and survival of the hydatid cyst.     

Immunohistochemical observations on cellular response in unilocular hydatid lesions and lymph nodes of cattle

As we believe the immunohistochemistry of the hydatid lesions and draining lymph nodes has never been studied, we collected them from the liver and lungs of cattle in Uruguay for such a study. Frozen sections of the tissues were immunohistochemically stained using monoclonal antibodies against surface markers CD2, CD4, CD5, CD8, B cell and granulocyte-monocyte/macrophage and antiserum against specific granules of bovine eosinophils. The adventitial layer of the cyst wall consists of a layer of epithelioid cells and connective tissue. The cells from the epithelioid cell layer were a kind of macrophage. In most cases having progressive hydatid cysts, CD8+ cells were predominant in the pericystic adventitia, and a relatively small number of CD4+ cells were in the same area. In the adventitial layer surrounding the regressive and involutional hydatid cysts, infiltrating lymphocytes were composed mostly of CD4+ cells. An eosinophil-mediated destruction of the laminated layer was recognized in the regressive and involuted hydatid cysts. The subpopulations of T cells in the local lymph nodes tended to be similar to T cells in the adventitial layer of hydatid lesions. From our findings, we consider that infiltration of eosinophils and the subpopulations of lymphocytes infiltrating the hydatid lesions in the liver and lungs are derived from cells in the draining lymph nodes of both organs.     

Hydatid cyst of the liver: a case report and literature review

Taiwan is nearly free from hydatid disease. We report a case of hydatid cyst of the liver in a 37-year-old man who originally lived in India and had migrated to Taiwan 2 years earlier. He presented with right upper quadrant pain and intermittent low-grade fever. Both sonography and computed tomography (CT) demonstrated a cystic lesion with vesicles at its periphery in segments 6 and 7 of the liver. A hydatid cyst was diagnosed. The patient underwent radical excision of the cyst with total removal without opening the wall. He also received pre- and postoperative oral mebendazole. Pathology showed a hydatid cyst consisting of three layers: the inner single nucleated geminal layer, the middle acellular laminated layer, and the outer pericyst originating from inflammatory and hepatic cells. This case highlights that accurate preoperative diagnosis of hydatid disease can be made from personal history, typical sonography and CT study in non-endemic areas.     

Role of endoscopic intervention in biliary complications of hepatic hydatid cyst disease

OBJECTIVE: Biliary complications of hepatic hydatidosis are often difficult to detect and manage. The aim of this study was to present our experience on the effectiveness of endoscopic treatment modalities in cases of biliary complications of hepatic hydatid cysts. MATERIAL AND METHODS: Over the past 10 years, 15 patients diagnosed with hepatic hydatidosis and manifesting symptoms and signs indicative of biliary involvement were examined by means of endoscopic retrograde cholangiopancreatography (ERCP) in our Gastroenterology Endoscopic Unit; 7 patients had already been operated on for hepatic hydatid cysts; one of them had a concomitant hydatid cyst in the lung. Diagnosis of the disease was based on a combination of ultrasonography (US), computed tomography (CT) and specific immunologic and/or microbiologic studies. RESULTS: Biliary complications of hydatid cysts were detected by ERCP in 9 patients (60%). Eight (88.9%) patients displayed a communication between the hydatid cyst or its residual cavity and the biliary tree; 5 patients had daughter cysts or residual hydatid material within the biliary tree, 1 patient had a biliocutaneous fistula, 1 patient a postoperative biliary leakage and 1 patient had only an opacification of the hydatid cyst during ERCP. In one patient, ERCP showed stenoses of both of the main hepatic ducts due to their compression by the cyst. Jaundice (88.9%), fever (33.3%) and right upper quadrant abdominal pain (88.9%) were the most frequent manifestations. These complications were demonstrated by US and CT imaging in only 25% of the cases. Four patients underwent ERCP before surgery and 5 after surgery. Endoscopic management was successful in all patients, resulting in clearance of the biliary tree, closure of fistulas, stopping of biliary leakage and jaundice remission. No serious endoscopy-related complications were recorded, with the exception of a pulmonary hydatid cyst rupture during ERCP. CONCLUSIONS: This study suggests that endoscopic treatment modalities are helpful and safe methods in the treatment of biliary complications of hepatic hydatidosis before and after definitive surgical management of the hydatid cysts.