PGL-1抗原和S-100蛋白检测在早期麻风病诊断中的意义

Detection of PGL-1 antigen and S-100 protein in the diagnosis of early leprosy

目的 : 为提高病理检查对早期麻风病的确诊率 ,从病原学、组织学及免疫学三方面了解麻风病早期皮损特征。方法 : 对 45例临床诊断和疑似的麻风皮损 ,采用常规病理和免疫组化法进行了抗麻风菌特异性PGL 1单克隆抗体、S 10 0蛋白染色。结果 : (1)连续切片的抗酸染色和PGL抗原检测可提高对早期皮损内抗酸菌 (AFB)及PGL抗原的发现率。AFB及PGL抗原多分布在真皮浅层、神经内/或神经束膜及周围血管浸润的组织细胞中 ;(2 ) 10例PGL抗原阳性的单个皮损麻风 ,7例AFB阳性。其中 5例神经内有AFB ,6例神经内有PGL抗原 ,4例神经内AFB及PGL抗原均阳性 ;(3)经S 10 0蛋白染色显示 ,未定类皮损组织学的非特异性炎性浸润 ,多是以淋巴细胞为主、有选择性的皮神经分支的炎性浸润 ,6 0 %具有特异性神经病变 ;(4)除皮损数不清的 3例外 ,单个皮损的确诊率为 41.6 % (10 / 2 4)。随着皮损数的增加 ,病理确诊率也增高 ;两块皮损和 3块以上的确诊率分别为 6 6 .6 % (6 / 9)和 88.8%(8/ 9)。结论 : PGL 1、S 10 0蛋白免疫染色 ,可提高早期麻风病的确诊率。

Objective:To improve the histological diagnosis of leprosy and understand the features of early leprosy based on pathogen, histology and immunology.Methods:Routine (HE,AF) and immunohistochemical stainings with monoclonal antibodies against PGL 1, S 100 protein were applied to tissue sections from 45 clinically diagnosed and suspected cases.Results:(1)Senstivity of AFB and PGL antigen detection can be significantly improved by examination of 20 or more serial sections. AFB and/or PGL were mostly found in the infiltrating cells of the subepidermal zone, intraneurium , perineurium and around blood vessels. (2)PGL antigen can be found in 10 confirmed single lesion leprosy but AFB was detected in 7 patients. Of which, AFB in nerve for 5 patients, PGL in nerve for 6 patients and both AFB and PGL in nerve for 4 patients. (3)S 100 protein staining demonstrated that nonspectific chronic inflammation in indeterminate leprosy presents as selective perineural and/or intraneural infiltration with lymphocytes predominating. (4)Except 3 cases with unknown number of lesions, the positive correlation between the number of lesions and immuno pathological confirmatory rate was found in nanely 41.6% (10/24) for single lesion, 66.6%(6/9) for 2 lesions and 88.8% (8/9) for patients with ≥3 lesions. Conclusions :Immuno histological study is helpful to improve histological diagnosis of early leprosy. [