炎症细胞在女性腺性膀胱炎膀胱黏膜下的浸润情况及临床意义

Inflammatory cells infiltration status in bladder submucosa of patients with cystitis glandularis and its clinical significance

目的分析女性腺性膀胱炎黏膜下炎症细胞浸润情况，探讨非可控性炎症在腺性膀胱炎中的作用。方法对2016年6—10月收治的10例已确诊的女性腺性膀胱炎患者的膀胱黏膜组织标本进行免疫组化染色检查，分析其炎症细胞的浸润情况和类型。另收集2006年12月至2017年8月收治的49例腺性膀胱炎患者的临床资料及组织标本。年龄（36．0±8．1）岁；体重指数（21．4±4．1）kg／m^2；既往有高血压病病史19例，糖尿病病史18例。根据膀胱镜下的表现对腺性膀胱炎进行临床分型，将滤泡样水肿型、乳头瘤样型、肠腺瘤样型定义为高危组，慢性炎症型、黏膜无改变型定义为低危组。对49例组织标本采用免疫组化染色法检测，比较不同类型腺性膀胱炎患者的一般资料，分析膀胱黏膜炎症细胞浸润程度及其与临床特征的关系。结果10例腺性膀胱炎患者膀胱黏膜及黏膜下组织中，炎症细胞高表达T淋巴细胞标志性抗体[CD3、CD43、CD4、CD8阳性细胞数分别为（195．2±21．1）、（201．5±19．5）、（159．6±10．9）、（225．2±12．8）个]，T淋巴细胞数量明显高于B淋巴细胞[CD20阳性细胞数为（20．0±4．3）个]和浆细胞[CD38、CD138阳性细胞数分别为（14．6±1．2）、0个]，差异均有统计学意义（P〈0．01）。49例中高危组28例，年龄（34．4±7．5）岁；体重指数（21．9±4．2）kg／m^2；合并高血压病8例，糖尿病8例。低危组21例，年龄（38．2±8．5）岁；体重指数（20．8±4．0）kg／m^2；合并高血压病11例，糖尿病10例。两组上述指标比较差异均无统计学意义（P〉0．05）。高危组膀胱过度活动症症状评分（OABSS）明显高于低危组[（10．4±2．6）分与（7．1±2．1）分，P〈0．01]；高危组生活质量评分（QoL）也明显高于低危组[（4．9±0．9）分与（4．1±0．8）分，P〈0．01]；高危组最大尿流率（Qmax）明显低于低危组[（11．4±3．6）mL／s与（15．8±3．8）m]／s，P〈0．01）；高危组T淋巴细胞数量明显高于低危组[（173．5±26．8）个与（119．5±21．2）个，P〈0．01）]。结论女性腺性膀胱炎患者膀胱黏膜下大量T淋巴细胞浸润，其浸润程度与临床病理分期密切相关，提示非可控性炎症可能与腺性膀胱炎发病及预后有关。

Objective To analyze the infiltration of inflammatory cells under the mucosa of female cystitis glandularis and the different inflammatory infiltration in different clinical pathological types of cystitis glandularis. Methods Immunohistochemical method was used to detect the bladder mucosal tissue samples of 10 female patients confirmed cystitis glandularis admitted from June 2016 to October 2016. The results of immunohistochemical staining were collected and statistically analyzed by the automatic microscopy and image analysis system. In addition, the clinical data and tissue sample of 49 cases of cystitis glandularis treated from December 2006 to August 2017 were collected. Age of 49 patients was （34.4 ±7.5） years old and BMI was （21. 9 ± 4. 2） kg/m2. There were 19 cases of hypertension and 18 cases of diabetes. According to the cystoscopic manifestations, follicular edema type, papilloma type, and intestinal adenomatosis type were defined as high risk. Chronic inflammatory type and mucosa unchanged type were defined as low risk. hnmunohistochemical staining was used to detect tissue samples,to compare the general data of different types of cystitis glandularis and the degree of infiltration of bladder mucosal inflammatory ceils. Results T lymphocytes were highly expressed in 10 patients, and B lymphocytes and plasma cells were not expressed or extremely low （ P 〈 0. 01 ）. Of the 49 patients, 29 were high risk type cystitis glandularis （follicular edema type, papilloma type, and intestinal adenomatosis type） , and 21 were low risk type （chronic inflammatory type and mucosa unchanged type）. The age of the high-risk group was （34, 4 ± 7.5） years old with BMI of （21.9 ±4.2） kg/m2, 8 cases of hypertension and 8 cases of diabetes. The age of the low-risk group was （38. 2 ±8. 5） years old with BMI of （20. 8 ±4.0） kg/m2, 11 cases of hypertension and 10 eases of diabetes. There was no statistically significant difference between two groups （ P 〉 0.05 ）. The OABSS of high-risk group（ 10.4 ± 2. 6） was significantly higher than that of low-risk group （7.1±2.1, P 〈 0, 01 ）. QOL of high-risk group （4.9 ±0.9 ） was significantly higher than that of low-risk group（4.1 ±0.8 ,P 〈0.01 ）. Qmax of high-risk group was （ 11.4 ±3.6） ml/s, significantly lower than that of low-risk group [ （ 15.8 ±3.8） ml/s, P 〈 0.01 1- The positive number of T lymphocytes of high-risk group was （ 173.5 ±26.8 ）, which was significantly higher than that of low-risk group（ 119.5 ± 21.2, P 〈 0.01 ）. Conclusions T lymphocytes infiltration is the major phenomenon in bladder submucosa of female patients with cystitis glandularis. The inilammatory infiltration by T lymphocytes could be associated with patient＇ s symptom and bladder＇s pathological changes.