慢性ITP时脾脏形态学及免疫组化探究.doc

慢性ITP时脾脏形态学及免疫组化探究 　【摘要】 目的 研究ITP时脾脏的病理形态及免疫组化特点。方法 应用光镜观察36例ITP脾脏的形态特征；用免疫组化S-P法检测CD3、CD4、CD8、CD20、CD41、CD43、CD45Ro、CD68、P53和PCNA在ITP脾脏组织中的表达情况。结果 本组男女之比为0.19:1，男性平均年龄24.5岁，女性平均年龄32.6岁。脾脏呈轻度肿大。主要组织学改变是白髓滤泡反应性增生，生发中心扩大，滤泡周边带增宽，中央动脉壁增厚、纤维化，微血管增生。CD8+细胞多于CD4+T淋巴细胞；含血小板抗原的CD41+和CD43+淋巴细胞主要分布于生发中心；PCNA+淋巴细胞在红、白髓中均呈弥漫而密集分布；CD68+组织细胞数量较正常增多，T、B淋巴细胞和组织细胞呈增殖现象。 结论 ITP脾CD8+淋巴细胞明显高于CD4+淋巴细胞和T、B淋巴细胞及组织增生现象提示辅助T淋巴细胞亚群比例失调和功能异常。DEX治疗ITP能有效缓解病情。 　　【关键词】 特发性血小板减少症；脾脏；病理学；免疫组织化学 　　Chronic idiopathic thrombocytopenic purpura:a pathologic and immunohistochemical study of the spleen 　　【Abstract】 Objective To investigate the pathomorphological and immunochemical features of the spleen in idiopathic thrombocytopenic purpura. Methods Light microscopy was used to study the morphologic characteristics of 36 cases of the spleen in idiopathic thrombocytopenic purpura. The expression of CD3,CD4,CD8,CD20,CD41,CD43,CD45Ro CD68,P53 and PCNA protein were detected in all cases with S-P immunohistochemical method. Results The ratio of the male with female is 0.19:1. The average age of the males is 24.5 years old. The average age of the females is 32.6 years old. The splenomegaly of the chronic ITP is low-grade. The main pathologic change is reactive follicular hyperplasia of the white pulp and germinal central enlarging and broaden of the marginal zone. The thick and fibrosis walls of middle spleen arteries. The CD8+ lymphocytes gt;CD4+ lymphocytes. The lymphocytes which express platlate antigen CD41 and CD43 mainly distribute in the center of the folliculas area. PCNA positive lymphocytes located difussly and densely in red pulp and white pulp. The increasing number of cells suggests the proliferation of T and B cells and histocytes.Conclusion In ITP patients, abnormal distribution of T lymphocyte subsets and changes of the proliferation of T and B lymphocytes and histocytes may imply the dysfunction of Th1/Th2. Treatment with DEX has beneficial effect of ITP. 　　【Key words】 idiopathic thro