MMP-7在胆道闭锁肝纤维化患者中的表达及临床意义

目的 研究基质金属蛋白酶7（MMP-7）与胆道闭锁（BA）患者肝纤维化分级、胆管反应程度之间的关系，探索其在肝纤维化进程中的作用及临床意义。方法 选取2017年6月—2018年4月我院收治的15例胆道闭锁患儿行Kasai手术时的肝活检组织（G1组），另选取2015年1月—2016年1月因行Kasai术后肝脏功能衰竭而行肝移植术的病肝组织41例（移植组），将移植组按Kasai手术与肝移植的间隔时间分为2组：G2组（28例，间隔时间＜2年）和G3组（13例，间隔时间≥2年）。采用HE染色观察3组患者肝脏纤维化程度，免疫组化染色检测MMP-7和CK-19蛋白在肝脏中的表达情况并进行半定量分析。结果 （1）免疫组化结果显示，MMP-7主要表达于胆管上皮细胞、增生的胆管、汇管区周围肝细胞，随着肝纤维化程度进展，胆管细胞及肝细胞MMP-7表达强度增加，且胆管细胞比肝细胞表达更为强烈。MMP-7在G1~G3组中的表达水平分别为（0.068±0.017）vs（. 0.093±0.017）vs（. 0.084±0.016），差异有统计学意义（F=10.541，P＜0.001），CK-19在3组的表达水平分别为（0.119±0.036）vs（. 0.157±0.040）vs（. 0.110±0.044），差异有统计学意义（F=7.296，P＜0.001），G2组MMP-7、CK-19蛋白表达水平明显高于其余2组（P＜0.05），G1组与G3组之间差异无统计学意义（P＞0.05）。（2）3组的肝纤维化程度分别为2（2，3）vs. 4（3，4）vs. 4（2，4）（H=17.785，P＜0.001），G2组纤维化程度明显高于其余2组，差异具有统计学意义（P＜0.017）。（3）相关性检验示：MMP-7蛋白表达量与肝纤维化程度呈弱正相关（rs=0.609，P＜0.001），但与胆管反应程度（CK-19）无明显线性相关性（r=0.007，P=0.962）。结论 MMP-7在BA患儿Kasai术后肝组织中高表达，并且随肝纤维化程度加重而表达升高，其可能参与并促进了BA肝纤维化进程，提示自体肝生存不佳。

Expression and clinical significance of MMP-7 in hepatic fibrosis of biliary atresia

Objective To investigate the relationship of matrix metalloproteinase-7 (MMP-7) in liver tissue of biliaryatresia (BA) with liver fibrosis and bile duct reaction, and explore the role of MMP-7 in the process of liver fibrosis and itsclinical significance. Methods Data of 15 BA patients with liver biopsy in Kasai operation in our hospital from June 2017to April 2018 were collected (G1 group)，and data of 41 patients with liver biopsy who underwent liver transplantation afterKasai operation from January 2015 to January 2016 were enrolled as transplantation group. The transplantation group wasdivided into two groups according to the interval time between Kasai operation and liver transplantation: G2 group (n=28, theinterval time was less than 2 years) and G3 group (n=13, the interval time was more than 2 years). Hematoxylin-Eosin (HE)staining was used to observe the degree of liver fibrosis. Immunohistochemical staining was used to detect the expressions ofMMP-7 and CK-19. Results (1) Immunohistochemical results showed that MMP-7 was mainly expressed in bile ductepithelial cells, hyperplastic bile ducts and hepatocytes around the portal area. With the progress of hepatic fibrosis, theexpressions of MMP-7 were increased in biliary duct cells and hepatocytes, and which were strongly expressed in biliaryduct cells than those of hepatocytes. Semi-quantitative analysis showed that the expression levels of MMP-7 were (0.068±0.017) vs. (0.093±0.017) vs. (0.084±0.016) in the three groups (F=10.541，P＜0.001). CK-19 staining showed that bile ductreactions of three groups were (0.119±0.036) vs. (0.157±0.040) vs. (0.110±0.044) (F=7.296，P＜0.001). The expression levels of MMP-7 and CK-19 protein were significantly higher in G2 group than those of other two groups (P＜0.05). There was nosignificant difference between G1 and G3 groups (P＞0.05). (2) The liver fibrosis in the three groups were 2 (2, 3) vs. 4 (3, 4)vs. 4 (2, 4) (H=17.785, P＜0.001), and the fibrosis was significantly higher in the G2 group than that of other two groups (P＜0.017). (3) Correlation test showed that the expression of MMP-7 protein was positively correlated with the degree of liverfibrosis (rs=0.609, P＜0.001), but there was no correlation with bile duct reaction (r=0.007, P=0.962). Conclusion Theexpression of MMP-7 protein is highly expressed in liver tissue after Kasai operation, and it increases with the severity of liverfibrosis. MMP-7 may participate in the process of BA liver fibrosis and suggest that the survival of autologous liver is poor.