蕈样肉芽肿与扁平苔藓、银屑病浸润细胞的免疫组化比较

Immuohistochemical comparison of infiltrating cells among mycosis fungoides,lichen planus and psoriasis

目的探讨免疫表型对蕈样肉芽肿与扁平苔藓、银屑病鉴别诊断的意义。方法应用ABC免疫组化技术检测15例蕈样肉芽肿,17例银屑病和17例扁平苔藓,6例正常人皮肤的CD1a、CD4、CD8、ICAM-1、LFA-1、HLA-DR(树枝状细胞)、CD30和CD7的表达情况。结果蕈样肉芽肿表皮CD1a,CD30,ICAM-1(单一核细胞P＜0．001,树枝状细胞P＜0．01)的阳性细胞密度明显高于扁平苔藓、银屑病、正常人皮肤。蕈样肉芽肿表皮CD4,CD8,HLA-DR的阳性细胞密度明显高于扁平苔藓。蕈样肉芽肿真皮中CD1a阳性细胞的线性密度(P＜0．01),真皮内ICAM-1和LFA-1阳性细胞百分比亦较扁平苔藓增多(P＜0．05)。蕈样肉芽肿表皮CD7阳性细胞与扁平苔藓、银屑病比较差异无统计学意义。银屑病和扁平苔鲜真皮内CD7阳性细胞百分比高于蕈样肉芽肿和正常人皮肤。结论蕈样肉芽肿和扁平苔藓、银屑病皮损CD1a、CD4、CD8、ICAM-1、LFA-1、HLA-DR、CD30和CD7免疫表型有差异,其结果可为探讨发病机制提供线索。

Objective To investigate the role of immunophenotyping in distinguishing mycosis fungoides （ MF ） from lichen planus and psoriasis. Methods The expression of CD1a, CD4, CDS, ICAM-1, LFA-1, HLA-DR, CD30 and CD7 was measured by ABC immunohistochemical technique in specimens obtained from lesional skin of 15 cases of MF, 17 cases of lichen planus and 17 cases of psoriasis, and in the skin of 6 healthy controls. Results In the lesional epidermis of MF, the density of cells positive for CD1a, CD30 or ICAM-1, was significantly higher （mononuclear cells, P 〈 0.001; dendritic cells, P 〈 0.01 ） than that in the lesional epidermis of lichen planus, psoriasis and in the skin of healthy controls. The density of cells positive for CD4 or CD8 and of dendritic cells positive for HLA-DR was higher in lesional epidermis of MF than in that of lichen planus. The linear density of CDla-positive cells （ P 〈 0.01 ）, the percentages of cells positive for ICAM-1 （ P 〈 0.05 ） or LFA-1 （ P 〈 0.05 ） were all higher in the lesional dermis of MF than in that of lichen planus. As far as the CD7-positive cell density was concerned, it was higher in the lesional dermis of lichen planus and psoriasis than in that of MF and skin of healthy controls （ P 〈 0.01 ）, while no difference was found between the epidermis of MF and that of lichen planus or psoriasis. Conclusion There are differences in the expression of CD1a, CD4, CD8, ICAM-1, LFA-1, HLA-DR, CD30 and CD7 in the lesional skin of MF, lichen planus and psoriasis, which may provide a clue to the pathogenesis of these diseases.