慢性炎性脱髓鞘性多发性神经根神经病周围神经细胞免疫与临床研究  

An immunopathological study on biopsied sural nerves of chronic inflammatory demyelinating polyradiculoneuropathy(CIDP)

作　　者：李放[1] 贾建平[1] 

机构地区：[1]首都医科大学宣武医院神经内科

出　　处：《卒中与神经疾病》2007年第3期165-169,共5页Stroke and Nervous Diseases

摘　　要：目的研究慢性炎性脱髓鞘性多发性神经根神经病(chronic inflammatory demyelinating polyradic-uloneuropathy,CIDP)细胞免疫染色结果与临床、电生理和病理的关系。方法经周围神经活检确诊的12例CIDP神经活检标本和10例其它神经系统疾病患者的周围神经标本,用免疫组织化学染色的方法标记神经内膜的淋巴细胞、巨噬细胞和表达鼠抗人白细胞DR抗原(HLA-DR)的细胞,并分别计数,比较2组患者阳性细胞数量;分析CIDP患者3种阳性细胞数与临床、电生理和病理的关系。结果CIDP组与对照组比较,鼠抗人白细胞共同抗原(LCA)单克隆抗体、鼠抗人巨细胞(CD68)单克隆抗体、HDL-DR单克隆抗体的计数均有明显差异,P值分别为0.001、0.006和0.002;CIDP组HLA-DR阳性计数与CD68阳性计数之间有明显差异,P值为0.04,神经内膜水肿的LCA计数和无水肿的LCA计数比较有明显差异,P值为0.03,CD68阳性细胞在感觉神经传导速度减慢、神经纤维中重度减少的患者较相应的亚组有明显增高,且有显著差异,P值均为0.01,HLA-DR阳性计数在神经纤维中重度减少的患者也较相应的亚组有明显增高,有统计学差异,P值为0.01。结论CIDP患者神经内膜的炎性细胞浸润是较多见的病理特点,并与神经内膜水肿有关,巨噬细胞的浸润与感觉神经传导速度减慢以及神经纤维数量减少有关,病程较长时巨噬细胞和雪旺氏细胞都可能为HLA-II类抗原的抗原提呈细胞,雪旺氏细胞可能不仅为抗原提呈细胞,还可能同时参与对髓鞘的吞噬与破坏。Objective To investigate the corelation between clinical characteristics and the infiltration of T cells, macrophages and Schwann cells in chronic inflammatory demyelinating polyradiculoneuropathy（CIDP）. Methods The expression of LCA, CD68, and class II antigen were studied by immunohistochemical stain in the biopsy specimens of 12 patients and 10 control cases with other neuropathies. Results were analysed statistically by Mann-Whitney-Wilcoxon test. Results We found significantly higher levers of LCA, CD68 and HLA-DR in CIDP patients than that in controls. The HLA-DR staining was also significantly more than CD68 in CIDP patients. In CIDP, increased numbers of LCA were associated with endoneurial edema, and increased numbers of CD68 positive were associated with low sensory nerve conduction velocity and decreased density of myelinated axons. HLA-DR postive staining was also associated with long course of the disease and decreased myelinated axons. Conclusions Endoneurial inflammation was common in CIDP, and was associated with endoneurial edema. Macrophage infiltration was associated with demyelinating features. The class II antigen may also be expressed by macrophages and Schwann cells in long disease course. Schwann cells might not only be antigen-presenting cells, but also participate in the process of demyelination in CIDP.

关 键 词：慢性炎性脱髓鞘性多发性神经根神经病 病理 免疫组织化学 

分 类 号：R741[医药卫生—神经病学与精神病学]