الفهرس 
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Abstract
Biliary atresia is a serious health problem and is considered the most common cause of pathologic infant jaundice and one of the most common reasons for liver transplantation in children. It is an important cause of chronic liver disease leading to cirrhosis in early years of life. It is a condition in which there is total or segmental obliteration of the biliary duct system. Several reports confirmed that the basic etiology is still not clear however it is generally falling into infection or autoimmune-immune mediated categories, with possibility of inherited predisposition The role of the immune system in bile duct injury and obstruction is poorly understood at present and is the focus of intense investigation. Many studies offer strong evidence for a Th1-mediated immune response focused within the portal tracts in biliary atresia that is not present in other, similar neonatal cholestatic disorders. Lymphocyte-mediated inflammatory damage of the bile ducts has been proposed as a potential mechanism in the pathogenesis of biliary atresia (BA). Fluorescent immunohistochemistry reveald an increase in CD8+ T cells, CD3+/CD4+ T cells, and Kupffer cells in the portal tracts in biliary atresia This may shed light on the potential therapeutic use of immunosuppressive therapy in the treatment of biliary atresia. Recent non controlled studies using corticosteroid therapy after the Kasai procedure suggested an improved overall survival rate compared with historical controls The aim of our study was to detect CD3 ,CD4 and CD8 T cells in biliary atresia cases in comparison to neonatal cholestasis other than biliary atresia Seventy nine individuals were enrolled in this study, 34 patients with BA and 35 patients with cholestasis due to causes other than BA. Ten normal liver donors were included as a control group. All patients underwent full history taking, thorough clinical examination and the following investigations: 1. Abdominal Ultrasonography (U/S). 2. Complete blood count. 3. Liver function tests (ALT, AST, GGT, Alk. ph, Albumin, total proteins, total bilirubin, direct bilirubin and prothrombin concentration) . 4. Hepatitis viral markers (HBsAg, HBcAb, HCV-Ab) by ELISA. 5. Serum antibodies for TORCH viruses (Toxoplasma, Rubella, Cytomegalovirus and Herpes simplex virus). 6. Duodenal tube aspiration (if needed for diagnosis) 7. Liver biopsy 8. Fluorescent immunohistochemistry staining for CD3, CD4 and CD8 in liver tissue Data were collected, coded and processed by statistical analysis (SPSS) statistical package version 13 on an IBM compatible computer and the results were put in tables and graphs.
Our result showed that: 1. BA and cholestasis group were age and sex matched (P>0.05). 2. predominance of negative consanguinity and negative family history in BA group with incidence of 79.4% and 97.1% respectively, ( P-value <0.05) 3. The occurrence of clay stool was found in 88.2%of BA group and in 34.3%of the cholestasis group (table 4) with a P-value<0.0001. 4. BA patients had hepatomegaly and splenomegaly (94.1%and 47.1% respectively) similarly to that in cholestatic patients (85.7%and 42.9% respectively). 5. There was significant statistical difference between both groups as regard non contractility of gall bladder with a P-value <0.0001, in cholestatic group was about 62.9% significantly higher than that in the B.A group our observation that the majority of BA group had non contractile GB (55.9% ), atretic GB(41.2% ) and ( 2.9%) had contractile GB 6. Asciteswas found with 17.6% in B.A group and 5.7% for cholestatic patients. 7. The mean level of GGT in BA group (941.26±624.479 U/L) was significantly higher than that in the cholestasis group (297.43±435.270 U/L) with a P-value <0 .0001. 8. There was no significant statistical difference between cholestasis group and BA group as regard the level of AST, ALT, ALP, Tb, Db, Alb and total protein. Their mean serum levels were elevated in both groups with P-value >0.05 for all. 9. Platelet was significantly higher in BA (470.41±199.491) than that in the cholestasis (323.49±183.271) group with P-value (P<0.05) .
10. There was significant statistical difference in the duodenal tubal aspirate between BA and cholestasis group with a P-value <0.0001. 11. The occurrence of ductular proliferation and bile plugs were significantly higher in BA (97.1% and 82.4% respectively) than other causes of cholestasis (31.4% and 34.3% respectively) with P-value< 0.0001. 12. There was significant statistical difference between BA(8.65±3.064) and cholestasis groups(1.922±7.69) as regard the mean of the fibrosis score with P-value 0.018. 13. The mean of CD3,CD4 andCD8 in patients with BA was significantly higher (46.1765±17.58352, 32.2059±12.38224 , 13.9706±6.24978 respectively) than that in cholestasis group (11.1429±14.85646, 8.7143±11.46240, 2.4286±4.75448 respectively) and control group(7.0000±18.88562, 5.0000±12.69296 , 2.0000±6.32456 respectively )with P-value <0.0001, with cut off values off 25, 12 and 2.5 respectively differentiating between BA and cholestatic Patients. 14. There was significant statistical positive correlation between CD3, CD4 and CD8 and BA total score (P< 0.05).and there was significant statistical positive correlation between CD3, CD4 and CD8 and significant negative correlation with fibrosis score in cholestasis group (P< 0.05). In conclusion, our results showed that CD3, CD4 And CD8 immunohistochemical staining in patients of BA and cholestasis group was not correlated with the disease severity but among the histopathological parameters in our study it had the best accuracy in discriminating patients with BA from those with other causes of cholestasis and would be a promising helpful tool when investigating patients with neonatal cholestasis.