特发性炎性肌病骨骼肌炎症浸润的组织病理学分析

Histologic Analysis of Inflammatory Infiltration in Skeletal Muscle of Idiopathic Inflammatory Myopathy

目的:研究多发性肌炎(PM)和皮肌炎(DM)患者骨骼肌组织中浸润的炎性细胞的类型、分布和定位,探讨它们在特发性炎性肌病(IIM)发病机制中的作用。方法:选取IIM患者肌肉组织标本45例,其中PM19例,DM26例。用免疫组织化学方法检测PM/DM患者骨骼肌组织中CD3、CD4、CD8、CD20、CD45RA和CD45RO分子的表达。结果:PM组肌组织的损伤主要表现为肌纤维坏死和肌内膜炎,而DM组主要表现为束周萎缩和血管周围炎。CD3、CD8和CD45RO分子在PM和DM患者肌组织中均有阳性表达,两组间表达量差异无统计学意义(P均>0.05),主要分布在PM/DM患者肌组织的肌内膜和血管周围处。而CD20、CD4、CD45RA分子在DM组的阳性表达量较PM组明显增多(P均<0.05),且主要分布在血管周围。结论:细胞免疫和体液免疫均参与了PM和DM的发病,而体液免疫在DM的发病中可能起更主要的作用。

Objective：To characterize the inflammatory cells and analyze the cellular distribution in skeletal muscle of idiopathic inflammatory myopathies （IIM）, and study their pathogenetic roles in IIM. Methods： Forty-five muscular biopsy specimens of patients with IIM （19 polymyositis and 26 dermatomyositis） were selected in study. Immunohistochemical staining was applied to detect expressions of CD3, CD4, CD8, CD20, CD45RA and CD45RO on PM/DM patients. Results：The major pathologic features in patients with PM were necrosis of muscular fibers and inflammatory infiltration on endomysium, while the characteristics in patients with DM were perifascicular atrophy and perivasculitis. The positive expression of CD3^＋ , CD8^＋ , CD45RO^＋ T lymphocytes were similar in PM and DM （P〉0. 05）, and they were more frequently found at the perivascular and endomysial regions in both groups. CD4^＋, CD20^＋, CD45RA^＋ T lymphocytes expressed more marked in DM group than those in PM group （P〈0. 05）, and mainly distributed at the perivascular regions. Conclusion： Both cellular and humoral immunity involved in the development of PM and DM, but humoral immunity play a more important role in DM.