间质性膀胱炎/膀胱疼痛综合征膀胱黏膜组织中肥大细胞活化和相关免疫因子的表达及意义

Expression and clinical significance of mast cells and related immune factors in interstitial cystitis/ bladder pain syndrome

目的探讨间质性膀胱炎/膀胱疼痛综合征(IC/BPS)患者膀胱黏膜组织中肥大细胞活化,以及白介素(IL)-6、IL-10和唾液酸结合免疫球蛋白样凝集素-8(Siglec-8)的表达及意义。方法收集2016年3月至2017年10月我院收治的21例IC/BPS患者的膀胱黏膜活检组织为IC/BPS组,9例行输尿管镜检查患者的正常膀胱黏膜活检组织为对照组。IC/BPS组男3例,女18例;年龄(56.2±3.4)岁;患者盆腔疼痛及尿频评分(PUF)为(24.6±3.6)分。对照组男4,女5例;年龄(63.0±5.1)岁。采用透射电镜观察IC/BPS组和对照组膀胱黏膜肥大细胞、浆细胞浸润情况。采用免疫组化染色法检测两组IL-6、IL-10、Siglec-8的表达;分析上述免疫指标表达程度与IC/BPS患者PUF评分的关系。结果IC/BPS组21例中18例在超微电镜下可观察到肥大细胞及浆细胞,对照组均未见肥大细胞或浆细胞。IC/BPS组IL-6表达(-)1例,(+)11例,(++)9例;对照组9例IL-6表达均(-),两组差异有统计学意义(P=0.001)。IC/BPS组IL-10表达(-)3例,(+)7例,(++)11例;对照组IL-10表达(-)7例,(+)2例,两组差异有统计学意义(P=0.001)。IC/BPS组Siglec-8表达(-)12例,(+)5例,(++)4例;对照组Siglec-8表达(-)7例,(+)2例,两组差异无统计学意义(P=0.214)。IL-6表达(-)者PUF评分21分,IL-6表达(+)者PUF评分低于(++)者[(23.2±3.2)分与(26.7.4-3.1)分,P=0.025)。IL-10表达(-)者PUF评分低于(++)者[(19.7±2.1)分与(27.1.4-2.5)分,P<0.001],而与(+)者差异无统计学意义[(22.7±1.8)分,P=0.062];IL-10(+)者PUF评分低于(++)者(P=0.001)。9例IL-6、IL-10表达均为(++)者PUF评分为(26.6±2.4)分,高于7例IL-6和IL-10均为(+)者的PUF评分[(21.6±2.2)分,P<0.01]。Siglec-8表达(++)和(+)者共9例,其PUF评分为(21.3±2.0)分,低于(-)者[(27.0±2.3)分,P<0.01]。结论 IC/BPS膀胱黏膜组织中可见肥大细胞活化、浆细胞浸润。IL-6和IL-10表达强弱程度与症状程度呈正相关,Siglee-8表达强弱程度与症状程度呈负相关。

Objective To investigate the significance of mast cells activation,and IL-6,IL-10, sialic acid-binding immunoglobulin-like lectins 8(Siglec-8)expression in interstitial cystitis/bladder pain syndrome.Methods Bladder mucosal biopsy tissues of 21 patients with IC/BPS admitted to our hospital from March 2016 to October 2017 were taken as the IC/BPS group,and normal bladder mucosa biopsy tissues of 9 patients who underwent ureteroseopy were taken as the control group.In the IC/BPS group,there were 3 males and 18 females aged (56.2±3.4)years,and the patients'pain symptom score (PUF)was (24.6±3.6).Four males and five females in the control group were aged (63±5.1)years.The infiltration of bladder mucosa mast cells and plasma cells in IC/BPS group and control group was observed by transmission electron microscopy.The expression of IL-6,IL-10 and Siglec-8 were detected by immunohistochemical staining.The relationship between the expression level of the immune index and the PUF score was analyzed.Results In the IC/BPS group,mast cells and plasma cells was observed in 18 of the 21 cases,but no mast cells or plasma cells were observed in the control group.Expression of IL-6 in IC/ BPS group 1 case (-),11 cases(+)and 9cases (++).IL-6expression in the control group 9 cases were all (-).The difference of IL-6 expression between the IC/BPS group and the control group was statistically significant (P =0.001).Expression of IL-10 were 3 cases (-),7 cases (++),11cases (++)in IC/BPS group,while 7 cases (-),2 cases (++),and 0 cases (++)in the control group, and there was significant difference between the two group (P =0.001).In the IC/BPS group,expression of Siglec-8 were 12 cases (-),5(+),4(++),while in control group 7cases (-),2(+),and 0 (++),no statistically significant difference was found between the two group (P =0.214).The PUF score of the patients with IL-10 expression (-)was 19.7+2.1,lower than those with IL-10(++) (27.1+2.5,P <0.001).PUF of patients with IL-10(+)was 22.7±1.8,lower than those with (++) (P=0.001).The PUF score of IL-6 expression (-)was 21.The PUF score of IL-6 expression (+)was (23.2+3.2),lower than (++)(26.7+3.1,P =0.025).The PUF score of (++)IC/BPS patients was (26.6±2.4),higher than that of (+)IC/BPS patients (21.5±2.1,P <0.01).The PUF score of Siglec-8expression (++)and (+)in IC/BPS group was (21.3±2.0),lower than that of Siglec-8 (-)(27.0±2.3,P <0.01).Conclusions Mast cells and plasma cells were expressed in IC/BPS tissues.The expression of IL-6 and IL-10 was positively correlated with clinical symptoms,while the expression of Siglec-8 was negatively correlated with clinical symptoms.