免疫细胞的种类与分布在炎症性肠病诊断中的意义

发布时间：2018-06-29 19:01

本文选题：炎症性肠病 + 免疫细胞　；参考：《中国人民解放军医学院》2014年博士论文

【摘要】：【目的】炎症性肠病(IBD)是一种常见的慢性肠道病，主要包括溃疡性结肠炎(UC)和克罗恩病(CD)。临床对UC及CD的确诊依靠肠镜及病理活检,但是病理医生依靠肠镜取到的标本很难给出明确的诊断,这主要是由于缺乏有效可行的诊断依据和鉴别诊断要点。IBD的确切病因还不清楚，但是免疫因素日益受到人们的重视。目前为止，IBD粘膜免疫细胞的形态学变化规律很少有人研究。我们希望通过对IBD肠粘膜内免疫细胞种类与分布的研究,寻找新的鉴别诊断线索。【方法】选取病例，，参照2012年中华医学会消化病学分会新制定的诊断标准，结合临床病史及内窥镜下表现重新做出诊断。最后确定UC30例，CD26例，另外选取10例正常肠粘膜作为对照组。所有病例均重新HE染色及应用两步法加做13项免疫组化染色（CD1a、CD3、CD5、CD20、CD21、CD43、CD68、CD79α、CD138、CD163、S-100、PC、Ki-67）。所有切片均扫描进入优纳ISCAN系统进行半定量分析。统计学方法应用SPSS13.0统计软件对数据进行分析。免疫组化染色还进行了定性分析，分为弱（+）、中（++）、强（+++）三级。【结果】CD与UC的HE染色上的细胞数比较没有统计学意义，但UC及CD的细胞数与正常对照组相比均具有显著的统计学意义（p0.01）。组织细胞染色： CD1a在正常肠粘膜及UC内几乎没有表达， CD统计分析比较与正常对照组及UC均有统计学意义(p0.05)。CD21三者的差异可能是其它细胞着色的结果，在组织学上的鉴别诊断意义不大。S-100染色阳性的细胞种类很多，S-100三组的组间比较均具有统计学意义（p0.05）。CD68的UC组与正常对照组比较不具有统计学意义p0.05）。而CD组的阳性细胞数少于正常对照组和UC组，与UC及正常对照组比较均具有统计学意义（p0.05）。CD163染色时CD与正常对照组比较具有统计学意义（p0.05）。 T淋巴细胞染色： CD3在UC组固有层内分布密集，并与血管紧密接触。CD的CD3阳性细胞散在。三组的组间比较均具有统计学意义（p0.05）。CD5的阳性细胞数量比CD3要少，UC组CD5的阳性细胞分布与CD3大致相同。CD的CD5阳性细胞的分布要比CD3稍少一些。三组的组间比较也都具有统计学意义（p0.05）。正常对照组CD43固有层内的分布要比CD3密集。UC组固有层内密集分布。CD：CD43固有层内细胞密集CD43分子在三组的组间比较均具有统计学意义（p0.05）。 B淋巴细胞染色：正常对照组CD20粘膜固有层内只有个别阳性细胞。UC组CD20在固有层内散在个别阳性细胞。CD：CD20固有层内几乎（-）CD20在三组之间的组间比较结果均具有统计学意义（p0.05）。正常对照组CD79α在粘膜固有层内可见阳性细胞。UC组CD79α在固有层内密集分布。CD：CD79α固有层内散在分布。三组的组间比较均具有统计学意义（p0.05）。正常对照组CD138固有层内阳性细胞分布较少。UC组CD138在较浅的固有层++。CD组CD138在已经形成肉芽肿的区域（++），上皮细胞之间（+）。三组的组间比较具有统计学意义（p0.05）。正常对照组PC固有层内数量较多。UC组固有层内大量阳性细胞。CD组PC大片阳性细胞（++）。三组的组间比较均具有统计学意义（p0.05）。增殖活性比较：正常对照组Ki67只有个别上皮细胞阳性。UC：Ki67：腺体及滤泡中心区++，固有层++，滤泡周边-。CD：Ki67阳性细胞约占1-2%。三组的组间比较均具有统计学意义(p0.05)。【结论】可以通过多种免疫组化染色结果综合判断IBD的免疫状态及对UC和CD进行鉴别诊断。CD1a:UC(-),CD(+);Ki67UC(+10%),CD(+1-2%);S-100、CD3、CD20的阳性细胞数UC〉CD，细胞分布不同；PC的阳性细胞数UCCD,细胞分布不同。其他抗体可以作为辅助诊断手段。
[Abstract]:[Objective] inflammatory bowel disease (IBD) is a common chronic intestinal disease, mainly including ulcerative colitis (UC) and Crohn's disease (CD). The diagnosis of UC and CD depends on enteroscopy and pathological biopsy, but the pathologists rely on enteroscopy for a difficult to give a clear diagnosis. This is mainly due to the lack of effective and feasible diagnostic basis. The exact cause of the differential diagnosis of.IBD is not clear, but the immune factors are getting more and more attention. So far, the morphological changes of IBD mucosal immune cells are rarely studied. We hope to find new differential diagnostic clues by the study of the species and distribution of immune cells in the intestinal mucosa of IBD.
[Methods] to select the cases and to make a new diagnosis according to the new diagnostic criteria of the Chinese Medical Association in 2012, combined with the clinical history and the manifestations under endoscopy. Finally, UC30 cases, CD26 cases, and 10 normal intestinal mucosa were selected as the control group. All cases were re HE staining and 13 immunization groups were added by the two step method. Chemical staining (CD1a, CD3, CD5, CD20, CD21, CD43, CD68, CD79 alpha, CD138, CD163, S-100, PC). All slices were scanned into the semiquantitative analysis. Statistical methods were used to analyze the data. Immunohistochemical staining was also carried out qualitative analysis, divided into weak (+), medium (+ +), and strong (+ + +) three levels.
[results] the number of cells on HE staining of CD and UC was not statistically significant, but the number of cells in UC and CD had significant statistical significance compared with that of the normal control group (P0.01).
Histiocytic staining:
There was almost no expression of CD1a in normal intestinal mucosa and UC. The statistical analysis of CD compared with normal control group and UC (P0.05).CD21 three may be the result of other cell coloring. In histological diagnosis, there are many different types of positive cells with no.S-100 staining, and all of the groups of S-100 three have the same group. The UC group of.CD68 (P0.05) had no statistical significance compared with the normal control group, but the number of positive cells in the CD group was less than that of the normal control group and the UC group. The ratio of CD to the normal control group was statistically significant (P0.05) compared with the normal control group (P0.05) and the normal control group (P0.05).
T lymphocyte staining:
The distribution of CD3 in the lamina propria of UC was dense, and the CD3 positive cells with close contact with the blood vessels were scattered in the three groups. The number of positive cells in the three groups was less than that of CD3, and the distribution of the positive cells of CD5 in UC group and CD3 was slightly smaller than that of CD3. The comparison between groups of the three groups was compared. There was also statistical significance (P0.05). The distribution of CD43 propria in the normal control group was more significant than that of the dense distribution of.CD:CD43 proprs in the lamina propria of CD3 intensive.UC group (P0.05) in the three groups.
B lymphocyte staining:
In the lamina propria of the normal control group, only a few positive cells in the lamina propria.UC CD20 scattered within the lamina propria of the positive cell.CD:CD20 propria almost (-) CD20 between the three groups was statistically significant (P0.05). The normal control group of CD79 alpha in the lamina propria.UC group CD79 alpha in the lamina propria The distribution of internal dense distribution of.CD:CD79 alpha propri was distributed. The comparison between the three groups was statistically significant (P0.05). The positive cells in the CD138 lamina of the normal control group were less distributed in the.UC group CD138 in the shallow lamina propria ++.CD group CD138 in the granulomatous region (+ +) and the upper cutaneous cells (+). The comparison of the three groups was statistically significant. The study significance (P0.05). In the normal control group, the number of PC proprs in the normal control group was large in the propria of.UC group, and a large number of positive cells in the.CD group were positive cells (+ +) of PC blockbuster. The comparison between the three groups was statistically significant (P0.05).
The comparison of proliferation activity:
In the normal control group, Ki67 was only.UC:Ki67 positive in individual epithelial cells: the gland and the central region of follicular + +, propria + +, and the -.CD:Ki67 positive cells around the follicular group accounted for a statistically significant difference between the groups of 1-2%. three groups (P0.05).
[Conclusion] the immunological status of IBD and the differential diagnosis of.CD1a:UC (-), CD (+), CD (+), Ki67UC (+10%), CD (+1-2%), S-100, CD3, CD20 cells are different, and the cell distribution is different, and the number of positive cells is different. Other antibodies can be used as auxiliary diagnosis. Means.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R574

【共引文献】