手足口病中枢神经系统免疫细胞的分布、数量及意义

Distribution and quantity of various immunocytes in central nervous system of fatal hand-foot and mouth disease and their significance

目的探讨手足口病(hand-foot and mouth disease,HFMD)中枢神经组织中各种免疫细胞的状态。方法采用免疫组化SuperVision两步法检测7例HFMD尸检病例的中枢神经组织中T、B、NK和巨噬/小胶质细胞的分布及数量。结果 HFMD死亡患儿中枢神经系统形态符合炎症性病变,以淋巴单核细胞为主的炎细胞主要集中于中脑/脑桥、延髓和脊髓,有血管套和胶质小结形成,大脑和小脑改变较轻微。炎细胞CD3+、CD4+、CD8+T细胞及B细胞和巨噬/小胶质细胞,其计数在中脑/脑桥、延髓和脊髓均明显高于大脑和小脑(P<0.05),CD3+T细胞和巨噬/小胶质细胞计数均明显高于B细胞(P<0.05)。HFMD组和对照组均未见CD57+NK细胞。结论 HFMD患儿中枢神经系统的炎症病变呈"上轻下重"趋势,T、B淋巴细胞介导的细胞、体液免疫以及巨噬/小胶质细胞参与的固有免疫共同参与了HFMD患儿中枢神经病变的局部免疫应答。

Purpose To investigate the status of various immunocytes in central nervous system （CNS） tissues of fatal hand-foot and mouth disease （HFMD）. Methods Immunohistoehemistry was performed to analyze the distribution and quantity of T, B, NK and macrophages/microglia cells in CNS tissues in 7 autopsies of HFMD. Results Morphologically, inflammation was confirmed in the CNS of HFMD. Different inflammatory cells, mainly including lymphocytes and monocyte-macrophages, located densely in midbrain/ pons, medulla oblongata and spinal cord, respectively. Perivascular inflammatory cells infiltration or cuffing, as well as microglia nodules were observed. The brain and cerebellum were infected only slightly. These inflammatory cells were demonstrated with immunohis-tochemistry to be CD3 positive （ CD3 ＋ ）, CD4＋ , CD8 ＋ T cells, B cells and macrophages/microglia cells. Their numbers were markedly higher in midbrain/pons, medulla oblongata and spinal cord than those in brain and cerebellum （ P 〈 0. 05 ）. There were remarkable more CD3 ＋T lymphocytes and macrophages/microglia cells than B lymphocytes （ P 〈 0. 05 ）. No CD57 ＋ NK cells were found in all tissues examined in both HFMD and control group. Conclusion The inflammatory lesions present more seriously in the lower parts （midbrain/pons, medulla oblongata and spinal cord） than in the upper parts （brain and cerebellum） in the CNS of HFMD. Cel- lular immune mediated by T lymphocytes, humoral immune mediated by B lymphocytes and innate immune executed by macrophage/ microglial cells are involved corporately in the local immune response of the CNS lesions of HFMD.