Study On The Infiltration Levels Of CD4~+T Cells,IL-6,IL-8,IL-33 In Liver With Biliary Atresia And Postoperative Cholangitis And Clearance Of Total Bilirubin

Objective:To investigate the relationship between the expression of CD4~+T cells and inflammatory cytokines IL-6,IL-8,IL-33 in the liver of biliary atresia(BA)and the occurrence of postoperative cholangitis and early jaundice,as well as the relationship between the age of operation and the level of hepatic inflammatory infiltration and postoperative cholangitis.Methods:The study included 29 cases of BA and 16 cases of CBD diagnosed by preoperative ultrasound,intraoperative cholangiography and pathology in our hospital from June 2018 to May 2020.HE staining was used to evaluate the morphology and distribution of inflammatory cells in the liver.Immunohistochemistry was used to examine the expression and distribution of CD4~+T cells and inflammatory cytokines IL-6,IL-8,and IL-33 in the liver.We recorded the preoperative total bilirubin(TBIL)values and TBIL levels as well as cholangitis incidence of each BA child at 1st,2nd week and 3rd month after operation,which were analyzed correlatedly with the levels of liver inflammation.The BA group was divided into cholangitis group and non-cholangitis group according to the occurrence of postoperative cholangitis.The postoperative cholangitis was divided into early cholangitis,late cholangitis,frequent cholangitis and occasional cholangitis by its occurrence time and frequency.According to the age of operation,the BA group was divided into three groups:≤60 days,60-90days,and≥90 days.The correlation analysis was conducted with the degree of inflammatory cell infiltration,the expression of inflammatory factors,the occurrence of postoperative cholangitis and age,respectively.Results:HE staining showed that the hepatic portal area was infiltrated with numerous inflammatory cells,intrahepatic cholestasis,bile ducts hyperplasia,and hepatocyte edema in the BA group,while the area was infiltrated with mild inflammatory cell infiltration in the CBD group.Immunohistochemical results suggested that the expressions of CD4~+T cells and inflammatory cytokines IL-6,IL-8,and IL-33 in the BA group were higher than those in the CBD group(P<0.05).ROC curve analysis showed that the area under the curve of CD4~+T cells,IL6 and IL8 were0.869,0.886 and 0.838 respectively(P<0.001).The expression of CD4~+T cells,IL-6,and IL-8 in the cholangitis group was higher than that in the non-cholangitis group(P<0.05).The expression of CD4~+T cells in the early cholangitis group was higher than that in the late cholangitis group(P=0.024).The expression levels of CD4~+T cells,IL-6,IL-8 and IL-33 in frequent cholangitis group were slightly higher than those in incidental cholangitis group.The positive level of CD4~+T cells was negatively correlated with decrease ratio of the TBIL on the 3rd month after operation,which had statistical significance(P=0.034).The expression of IL-8 and IL-33 were negatively correlated with the decrease ratio of TBIL 1st week after operation(P<0.05).There was no significant difference between the expression of CD4~+T cells,IL-6,IL-8 and IL-33 the age of operation(P>0.05)and the association of age and postoperative cholangitis occurrence was showed to be not significantly different(P=0.057).Conclusion:A large number of CD4~+T cells and inflammatory cytokines IL-6,IL-8and IL-33 were infiltrated in the hepatic tissue of BA.High expression levels of CD4+T cells and inflammatory factors IL-6,IL-8,and IL-33 in the liver of biliary atresia may predispose to concurrent cholangitis,and high expression levels of CD4~+T cells may predispose to concurrent early cholangitis.CD4~+T cells,IL-8,and IL-33 may be predictors of early jaundice clearance.The age of operation had no effect on the level of liver inflammatory infiltration,which showed that the age of operation may not be a risk factor for postoperative cholangitis.