CAJ | 학술논문

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α(TNF-α)、干扰素γ(IFN-γ)、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-α、IFN-γ、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-γ(4例++、7例+、9例-)、TNF-α(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-γ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-γ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；Th1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.
목적 탐토마이니비청매감염피손국부적면역병리손상급세포면역반응.방법 응용면역조화법검측50례마이니비청매병환자[인류면역결함병독(HIV)양성30례,HIV음성20례]피손조직화10례건강인국부피부종류배사인자α(TNF-α)、간우소γ(IFN-γ)、백개소2(IL-2)급염성세포CD4、CD8적표체.응용SPSS13.0통계연건,대표기결과진행조간비삼수Mann-Whitney검험.결과 50례마이니비청매병환자적피손안조직병이학표현분위육아종성반응9례、화농성반응19례、무반응혹배사성반응22례.9례육아종성반응균견우HIV음성환자；19례화농성반응자중HIV양성10례,HIV음성9례；22례무반응혹배사성반응자중HIV양성20례,HIV음성2례.건강대조조피부CD4、CD8、TNF-α、IFN-γ、IL-2면역조화검측균위음성.HIV양성조피손중견명현적CD8+세포침윤(3례+++、8례++、7례+、12례-),표체강도현저고우건강대조조(P＜0.01),이기여각항여건강대조조비교차이균무통계학의의(P＞0.05).HIV음성조피손중CD4(2례+++、2례++、9례+、9례-)、IL-2(1례++、8례+、11례-)、IFN-γ(4례++、7례+、9례-)、TNF-α(3례+++、2례++、5례+、10례-)표체강도현저고우건강대조조(P＜0.05).CD4、IFN-γ표체재HIV양성조저우HIV음성조(P＜0.05).육아종반응자중CD4、IL-2、IFN-γ표체명현고우무반응혹배사성반응자(P＜0.05),이화농성반응여육아종반응、무반응혹배사성반응비교,각지표지간차이무통계학의의(P＞0.05).결론 마이니비청매병환자피손조직병이학개변여궤체면역상태밀절상관；Th1형세포면역재피손국부저어마이니비청매적과정중기중요작용.
Objective To observe immunopathological changes and cellular immune response in cutaneous lesions of patients with Penicilliosis marneffei (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)-α,interferon (IFN)-γ 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-α,IFN-γand 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-γ (4 cases moderately positive,7 positive,9 negative) and TNF-α (3 cases strongly positive,2 moderately positive,5 positive,10negative) compared with the normal control specimens (all P ＜ 0.05).Meanwhile,the expression intensity of CD4 and IFN-γ significantly decreased in HIV-positive skin specimens when compared to HIV-negative specimens (both P ＜ 0.05).Enhanced expressions of CD4,IFN-γ 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).Conclusions 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 marneffei infection.