自身免疫性甲状腺疾病和亚急性甲状腺炎树突状细胞与HLA-DR抗原表达观察

Observation of dendritic cell and HLA-DR antigen expression in autoimmune thyroid diseases and subacute thyroiditis

目的 探讨树突状细胞 (DC)和HLA -DR抗原表达在Graves病 (GD)、桥本甲状腺炎(HT)和亚急性甲状腺炎 (SAT)发病中的作用。方法 用组织化学、免疫组织化学方法观察有明显淋巴细胞浸润的GD 5 3例、HT 5 2例和SAT 31例甲状腺实质和间质中DC和HLA DR抗原表达的免疫活性细胞和甲状腺滤泡上皮细胞的病理形态学变化 ,并结合形态计量学方法 ,进一步探讨他们与GD、HT和SAT病理学分型、临床症状、体征及与自身免疫性甲状腺疾病和SAT发生、发展的关系。结果 GD、HT各型和SAT不同病变区中S 10 0阳性DC和HLA DR抗原表达的甲状腺滤泡上皮细胞随着浸润程度的进展逐渐增加。在HT的O 型和SAT的肉芽肿区达最高峰 ,HT的P 型和SAT的明显纤维化区则明显减少 ;而HLA DR抗原表达的免疫活性细胞数量却为最高峰。DC和HLA DR抗原表达的免疫活性细胞分布在甲状腺滤泡间、滤泡上皮细胞间并与弥漫浸润的淋巴细胞、浆细胞、巨噬细胞等相混杂 ,有些还分布在淋巴滤泡或肉芽肿中 ,并与相邻细胞密切接触。结论 本研究结果提示DC和HLA DR抗原阳性细胞共同协调发挥的甲状腺自身抗原递呈作用和直接杀伤的细胞毒作用在GD、HT和SAT发生、发展的免疫发病机制中可能存在着一定的联系。

Objective To investigate the effects of dendritic cell (DC) and HLA-DR antigen expression in the generation and development of Graves′ disease (GD), Hashimoto′s thyroiditis (HT) and subacute thyroiditis (SAT). Methods A morphologic study was performed on the thyroid tissue of 53 GD with pronounced lymphocytic infiltration, 52 HT and 31 SAT to investigate the pathologic changes of DC and HLA-DR antigen positive cell in the parenchymal cells and intestitial tissue by histochemical, immunohistochemical and electron microscopic technique and statistic analysis. Results The observation on DC and HLA-DR positive infiltrating cell in GD, HT and SAT showed a similar increase with the degree of cellular infiltation. The highest peaks of DC and HLA-DR positive thyroid follicular epithelium were in HT O-type and granulomatous area of SAT. The highest peaks of HLA-DR positive immunoactive cells was in HT P-type and fibrous area of SAT. Conclusion DC and HLA-DR positive cells may play an important role in the antigen-presenting step as well as in their direct cytotoxicity. These processes are related to the pathogenesis of AITD (GD and HT) and SAT. The thyroid follicules may be destroyed in the autoimmune reaction, and initially the patient presents hyperthyroidism and finally hypothyroidism follows because of the fibnosis of the follicules.