眼眶炎性假瘤发病机制的免疫组织化学研究

The pathogenesis of orbital inflammatory pseudotumor demonstrated by immunochemistry

目的通过研究11种单克隆抗体在各型眼眶炎性假瘤(OIPT)中表达的不同,探讨各型OIPT的免疫病理及发病机制。方法使用CD45RO、CD20、IgG、IgA、IgM、κ、λ、MSA、SMA、Vim、CD6811种单克隆抗体,以免疫组织化学染色SP法,对39例OIPT术后标本进行免疫组织化学标记。结果CD45RO、IgG在3种病理类型OIPT中的表达差异有统计学意义;CD68在淋巴细胞浸润型OIPT和硬化型OIPT中的阳性表达率分别为20%和56%;SMA、MSA、Vim在硬化型OIPT中阳性表达率为100%;5例混合型OIPT中,4例为多克隆性,1例为B细胞单克隆性。结论淋巴细胞浸润型OIPT的发病机制为Ⅲ型超敏反应和Ⅳ型超敏反应;硬化型OIPT的发病机制为组织内细胞外基质(ECM)异常增多和过度沉积,导致眼眶组织纤维化;混合型OIPT的发病机制涉及与淋巴细胞浸润型及硬化型OIPT不同的免疫反应路径。

Objective To understand the pathogenesis of three different types of orbital inflammatory pseudotumor （OIPT） and provide the theoretical references for clinical schemes and evaluation of prognosis. Methods Tissue sections from thirtynine cases of OIPT （lymphocyte infiltrative type,sclerosing type and mixed type） were studied for the expressions of-CD45RO, CD20, IgG, IgA, IgM, κ, λ, vimentin （ Vim ） , smooth muscle actin （ SMA ） , muscle specific actin （ MSA ） and CD68 by the SP immunohistochemisry. Results Expressions of CD45RO, IgG and CD68 were significant different among 3 histopathological patterns of OIPT（x^2 = 14. 958,P = 0. 021 ;X^2 = 12. 878,P = 0. 045 ;X^2 = 14. 574,P = 0. 024 respectively）. SMA, MSA and Vim were expressed in all 9 specimens with sclerosing OIPT. Among other 5 specimens of mixed OIPT, CD45RO and CD20 were positive in 4 specimens,and 1 specimen was only positive for CD20. Conclusion The pathogenesis of lymphocyte infiltrative OIPT is related with plenty of inflammatory cells accumulation ;while sclerosing OIPT characterized by orbital fibrosis result from extracellular matrix abnormal aggradations. Mixed OIPT is from the combination effect of two factors motioned above.