巨细胞动脉炎跳跃区域的超微结构特征及其意义

The ultrastructural features and it's significance of the skip area with giant cell arteritis

目的 研究巨细胞动脉炎 (GCA)颞动脉活检跳跃区域的超微结构特征及其意义。方法 对 2 0例GCA和 7例非GCA患者进行一侧颞动脉活检 ,根据光镜观察的结果 ,将GCA患者分为跳跃区域组 (14例 )和活跃期血管炎组 (6例 ) ;电镜观察 3组患者的血管超微结构 ,病理改变按 0～ 3分 4级评分。结果 超微结构的病理变化得分为 :GCA跳跃区域组 0分 1例 ,2～ 6分 9例 ,8～ 9分 4例 ;GCA活跃期血管炎组 7～ 15分 6例 ;非GCA组 0～ 1分 6例 ,5分 1例。经H检验 ,3组间差异有显著性 (P <0 0 1) ;两两比较发现 ,GCA跳跃区域组得分明显高于非GCA组 ,但低于GCA活跃期血管炎组得分。GCA跳跃区域组 ,其内膜超微结构变化突出 ,与GCA活跃期血管炎组比 ,差异无显著性 (P >0 0 5 )。结论 GCA颞动脉跳跃区域内有明显的病理改变 ,尤其是内膜。提示GCA跳跃区域超微结构的研究有助于GCA的诊断和治疗。

Objective To investigate the ultrastructural features and it's significance of the skip area with giant cell arteritis(GCA).Methods 20 GCA patients and 7 non-GCA patients underwent temporal artery biopsies. The sections were stained with HE and methylene blue(MB) for light microscopy(LM), doubly stained with uranyl acetate and lead curate for electron microscopy (EM). 20 GCA patients were divided into skip area GCA group(14 cases) and active inflammatory cell infiltration GCA group(6 cases) according to the definition of skip area or skip lesion. The ultrastructural changes of each group were observed by EM and assessed by using 4 grades from 0 to 3 scores.Results The scores of ultrastructural changes were as follows: the skip area GCA group, 0 in 1 patient, 2 to 6 in 9 patients, and 8 to 9 in 4 patients; the active inflammatory cell infiltration GCA group, 7 to 15 in 6 patients; the non-GCA group, 0 to 1 in 6 patients, and 5 in 1 patient. The scores of the three groups were tested by H check, the difference was evidently significant( P<0.01). When the scores were compared between each group by U test, we found the score in skip area GCA group was higher than that in non-GCA group, but lower than that in active inflammatory cell infiltration GCA group. The ultrastructural changes were dominantly located in the intima of artery in skip area GCA group, and there was not a significant difference ( P>0.05) in comparison with active inflammatory cell infiltration GCA group.Conclusions At electron microscopic level, the skip area of temporal artery biopsy with GCA showed obvious pathological changes, especially in the intima of artery. The results suggest that the investigation of ultrastructure features of the skip areas of temporal artery with GCA may be benefit for the diagnosis and treatment of this disease.