الفهرس 
Anatomy of the biliary tractOnly 14 pages are availabe for public view
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Abstract
Biliary atresia is a neonatal obstructive cholangio-pathy characterized by a destructive obliterative process affecting both the interahepatic and extrahepatic biliary tree that presents in the first months of life .The consequence of progressive inflammatory and sclerotic reaction is the development of obstructive jaundice.
Oligoclonal expansion of T cells in the liver tissues obtained at the time of biliary atresia diagnosis suggest that biliary atresia is an immune mediated disease and studies utilizing the rota virus-induced BA mouse model have established further evidence for avirus induced autoimmune mediated pathway of bile duct injury. (Yang et al, 2013)
The aim of this study was to investigate the role of T regulatory cells marked by Foxp3 in the pathogenesis of biliary atresia and the postoperative outcome.
The current study was conducted on 50 patients with cholestasis. They were classified into two groups, groupI included 25 patients with biliary atresia 13 females (52.0%) and 12 males (48.0%); their age ranging between (2 months: 6 months) with a mean of age 3.3± 1.8 months, and groupII included 25 patients with intrahepatic cholestasis 10 females (40.0%) and 15 males (60%); their age ranging between (2 months: 24 months) with a mean age of 8.7± 6.8 months. They were compared to each other clinically, biochemically and histopathologically.The biliary atresia group were followed for 3 months postoperative.
There was a highly significant decrement of the age percentile recorded in groupI than groupII .Although there was no significant difference between two groups as regards gender.
Transaminases in GroupI patients significantly improved postoperatively. Also a significant improvement of alkaline phosphatase was recorded postoperatively.
GroupI patients showed gradual improvement of total serum bilirubin and direct serum bilirubin but most of the infants did not clear their jaundice by third month postoperatively. Liver biopsy in the present study showed a significant increment of fibrosis, bile duct reaction, bile duct plugs, cholangitis, steatosis and rosetting in groupI.
Our study showed that 24 (96%) of patients were Foxp3 negative and 1 (4%) of patients was Foxp3 positive in cholestatic patients (controls) and 21 (84%) of patients were Foxp3 negative and 4 (16%) of patients were Foxp3 positive in biliary atresia with no significant difference between two groups as regared Foxp3 (P value 0.349). Absence of Foxp3 function results in the absence of regulatory T cells and its supprresive action leading to inflammatory disease, BA occur due to expression to early inflammation with decrease of Treg function, relatively lake of Treg cells around the bile ducts propagate the cholangitis and bile duct damage in BA suggesting that Foxp3 may have a role in pathogenesis of biliary atresia.
There were no significant differance of postoperative one month results of liver function tests and blood film between Foxp3 positive and Foxp3 negative cases except for alkaline phosphatase.
The results concluded that Foxp3 may have a role in biliary atresia pathogenesis.Foxp3 assessment in hepatic tissue is not of value in discriminating BA from other causes of cholestasis. As Foxp3 was of low expression in both BA and cholestasis, it may be playing a role in the pathogenesis of both conditions. Foxp3 assessment in liver tissue at time of doing Kasai operation is not of prognostic value as regards short term postoperative outcome up to 3 months
.