血清IgE增高的青年缺血性卒中患者颞动脉组织病理学研究

Histopathology of the temporal artery in young ischemic stroke patients with elevated serum immunoglobulin E

目的临床上部分青年缺血性卒中患者血清免疫球蛋白E(immunoglobulin E,Ig E)增高,推测为脑血管炎,但缺乏病理学依据。文中旨在通过颞动脉活检组织病理学研究探讨该类患者血管病变的特点。方法对2013年1月至2015年8月间在南京军区南京总医院神经内科住院的32例病因不明的青年缺血性卒中患者颞动脉标本进行组织病理学检查,其中血清Ig E正常者(正常组)与增高者(增高组)各16例。通过HE染色观察炎症细胞浸润灶,甲苯胺蓝染色检测肥大细胞,免疫组化检测基质金属蛋白酶9(matrix metalloproteinase 9,MMP-9)、单核细胞趋化蛋白-1(Monocyte chemotaxis protein-1,MCP-1)和Ig E等表达。结果与血清Ig E正常组相比,增高组患者颞动脉血管壁炎症细胞浸润呈现出更高的发生率(62.5%vs12.5%,P<0.01),1例伴外膜纤维素性渗出及小灶坏死的标本也见于Ig E增高组。Ig E增高组颞动脉MCP-1的平均光密度值[(9.25±5.79)×10^(-5)]高于正常组[(4.41±2.87)×10-5],差异有统计学意义(P<0.01)。MMP-9的平均光密度值和内中膜厚度在血清Ig E增高组中均呈增加的倾向,但组间比较差异均无统计学意义(P>0.05)。2组间肥大细胞计数差异无统计学意义(P>0.05)。结论血清Ig E增高组患者颞动脉血管壁炎症细胞浸润、坏死反应和纤维素性渗出可能是血管炎的一种表现,推测MCP-1在病变过程中可能起到一定的作用。

Objective Ischemic stroke with elevated serum immunoglobulin E（ Ig E） in some young patients is regarded as cerebral vasculitis clinically though without sufficient pathological evidence. This study was to investigate the characteristics of vascular lesions in these patients by temporal artery biopsy. Methods We performed histopathologic examinations on the temporal arteries of 32 young ischemic stroke patients with unknown etiology,16 with normal and the other 16 with elevated serum Ig E. We observed inflammatory cells infiltration and mast cells by HE staining and toluidine blue staining respectively and determined the expressions of matrix metalloproteinase-9（ MMP-9）,monocyte chemotaxis protein- 1（ MCP-1）and serum Ig E by immunohistochemistry. Results Compared with the patients with normal Ig E,those of the elevated Ig E group showed a significantly higher rate of inflammatory cells infiltration（ 12. 5% vs 62. 5%,P 0. 01）,with 1 case of focal necrosis and fibrinous exudation in the adventitia in the latter group. The average optical density（ OD） of monocyte chemotaxis protein-1（ MCP-1） in the temporal artery was also dramatically higher in the elevated Ig E group than in the normal controls（ [9. 25 ± 5. 79] × 10- 5vs[4. 41 ± 2. 87] × 10- 5,P 0. 01）. The average OD of matrix metalloproteinase 9（ MMP-9） and intima-media thickness were both increased in the elevated Ig E group（ [32. 79 ± 21. 38] × 10- 4and [0. 25 ± 0. 06] mm） but showed no statistically significant difference from those in the normal Ig E group（ [25. 23 ± 12. 78] × 10- 4and [0. 22 ± 0. 06] mm）（ both P 0. 05）. Nor was any significant difference observed in the number of the mast cells between the normal and elevated Ig E groups（ 2. 8 ± 1. 5 vs 3. 6 ± 2. 3,P 0. 05）. Conclusion The infiltration and necrosis of inflammatory cells and fibrin exudation in the temporal artery of the young patient with elevated serum Ig E are likely to be the manifestations of vasculitis,and MCP-1 may play a role in the pathogenesis of the disease.