摘要
目的探讨马尔尼菲青霉感染皮损局部的免疫病理损伤及细胞免疫反应。方法应用免疫组化法检测50例马尔尼菲青霉病患者[人类免疫缺陷病毒（HIV）阳性30例，HIV阴性20例]皮损组织和10例健康人局部皮肤肿瘤坏死因子ct（TNF-a）、干扰素Y（IFN-Y）、白介素2（IL-2）及炎性细胞CD4、CD8的表达。应用SPSS13．0统计软件，对标记结果进行组间非参数Mann—Whitney检验。结果50例马尔尼菲青霉病患者的皮损按组织病理学表现分为肉芽肿性反应9例、化脓性反应19例、无反应或坏死性反应22例。9例肉芽肿性反应均见于HIV阴性患者；19例化脓性反应者中HIV阳性10例，HIV阴性9例；22例无反应或坏死性反应者中HIV阳性20例，HIV阴性2例。健康对照组皮肤CD4、CD8、TNF-a、IFN-Y、IL-2免疫组化检测均为阴性。HIV阳性组皮损中见明显的CD8’细胞浸润（3例＋＋＋、8例＋＋、7例＋、12例-），表达强度显著高于健康对照组（P〈0．01），而其余各项与健康对照组比较差异均无统计学意义（P〉0．05）。HIV阴性组皮损中CD4（2例＋＋＋、2例＋＋、9例＋、9例-）、IL-2（1例＋＋、8例＋、11例-）、IFN-1（4例＋＋、7例＋、9例-）、TNF-仪（3例＋＋＋、2例＋＋、5例＋、10例-）表达强度显著高于健康对照组（P〈0．05）。CD4、IFN-．y表达在HIV阳性组低于HIV阴性组（P〈0．05）。肉芽肿反应者中CD4、IL-2、IFN-1表达明显高于无反应或坏死性反应者（P〈0．05），而化脓性反应与肉芽肿反应、无反应或坏死性反应比较，各指标之间差异无统计学意义（P〉0．05）。结论马尔尼菲青霉病患者皮损组织病理学改变与机体免疫状态密切相关；Thl型细胞免疫在皮损局部抵御马尔尼菲青霉的过程中起重要作用。
Objective To observe immunopathological changes and cellular immune response in cutaneous lesions of patients with Penicilliosis mameffei （PSM）. Methods Skin specimens were resected from cutaneous lesions of 50 patients with PSM, including 30 cases positive and 20 cases negative for human immunodeficiency virus （HIV）, and from the normal skin of 10 healthy human controls. Hematoxylin-eosin staining was performed to observe histopathological changes, and immunohistochemistry to determine the expression level of tumor necrosis factor （TNF）-a, interferon （IFN）-Y interleukin （IL）-2, CD4 and CD8, in these tissue samples. Results Three histological patterns were observed in the cutaneous lesions of PSM, including granulomatous reaction in 9 HIV-positive specimens, suppurative reaction in 10 HIV-positive specimens and 9 HIV-negative specimens, anergic or necrotic reaction in 20 HIV-positive specimens and 2 HIV-negative specimens. Immunostaining was negative for CD4, CD8, TNF-a, IFN-Yand IL-2 in the normal control skin. Of the 30 HIV-positive specimens, 3 were strongly positive, 8 mediately positive, 7 positive, and 12 were negative, for CD8. The expression intensity of CD8 was significantly stronger in HIV-positive specimens than in the normal control specimens （P 〈 0.01 ）,while no significant difference was observed for the expression of the other tested cytokines or molecules between the HIV-positive specimens and normal control specimens （all P 〉 0.05）. The HIV-negative specimens showed enhanced expression of CD4 （2 cases strongly positive, 2 moderately positive, 9positive, 9 negative）, IL-2 （1 case moderately positive, 8 positive, 11 negative）, IFN-Y （4 cases moderately positive, 7 positive, 9 negative） and TNF-a（3 cases strongly positive, 2 moderately positive, 5 positive, 10 negative） compared with the normal control specimens （all P 〈 0.05）. Meanwhile, the expression intensity of CDg and IFN-Y significantly decreased in HIV-positive skin specimens when compared to HIV-negative specimens （both P 〈 0.05）. Enhanced expressions of CD4, IFN-Y and IL-2 were observed in specimens with granulomatous reaction compared with those with anergic or necrotic reaction （all P 〈 0.05）, while the specimens with suppurative reaction showed no statistical differences in these parameters when compared to those with granulomatous reaction and anergic or necrotic reaction （all P 〉 0.05）. Concliom The histopathological changes in cutaneous lesions are closely associated with the immune status of patients with PSM, and T-helper type 1 immune response may play a pivotal role in the defense against Penicillium mameffei infection.
出处
《中华皮肤科杂志》
CAS
CSCD
北大核心
2013年第3期181-184,共4页
Chinese Journal of Dermatology
基金
国家自然科学基金（81060128,81271804）
国家自然科学基金一广东联合基金（U0932003）
广西自然科学基金（0991144,2012GXNsFAA053109）
广西2011年研究生教育创新计划（2011105981002M220）
