Kobayashi M, Ito M, Nakagawa A, Nishikimi N, Nimura Y
First Department of Surgery, Nagoya University School of Medicine, and the Department of Pathology, Nagoya University Hospital, Japan.
J Vasc Surg. 1999 Mar;29(3):451-8. doi: 10.1016/s0741-5214(99)70273-9.
The diagnosis of Buerger's disease has depended on clinical symptoms and angiographic findings, whereas pathologic findings are considered to be of secondary importance. Arteries from patients with Buerger's tissue were analyzed histologically, including immunophenotyping of the infiltrating cells, to elucidate the nature of Buerger's disease as a vasculitis.
Thirty-three specimens from nine patients, in whom Buerger's disease was diagnosed on the basis of our clinical and angiographic criteria between 1980 and 1995 at Nagoya University Hospital, were studied. Immunohistochemical studies were performed on paraffin-embedded tissue with a labeled streptoavidin-biotin method.
The general architecture of vessel walls was well preserved regardless of the stage of disease, and cell infiltration was observed mainly in the thrombus and the intima. Among infiltrating cells, CD3(+) T cells greatly outnumbered CD20(+) B cells. CD68(+) macrophages or S-100(+) dendritic cells were detected, especially in the intima during acute and subacute stages. All cases except one showed infiltration by the human leukocyte antigen-D region (HLA-DR) antigen-bearing macrophages and dendritic cells in the intima. Immunoglobulins G, A, and M (IgG, IgA, IgM) and complement factors 3d and 4c (C3d, C4c) were deposited along the internal elastic lamina.
Buerger's disease is strictly an endarteritis that is introduced by T-cell mediated cellular immunity and by B-cell mediated humoral immunity associated with activation of macrophages or dendritic cells in the intima.
血栓闭塞性脉管炎的诊断一直依赖于临床症状和血管造影结果，而病理结果被认为是次要的。对血栓闭塞性脉管炎患者的动脉进行组织学分析，包括对浸润细胞进行免疫表型分析，以阐明血栓闭塞性脉管炎作为一种血管炎的本质。
研究了1980年至1995年间在名古屋大学医院根据我们的临床和血管造影标准诊断为血栓闭塞性脉管炎的9例患者的33个标本。采用标记链霉亲和素-生物素法对石蜡包埋组织进行免疫组织化学研究。
无论疾病处于何阶段，血管壁的总体结构保存良好，细胞浸润主要见于血栓和内膜。在浸润细胞中，CD3(+) T细胞的数量大大超过CD20(+) B细胞。检测到CD68(+)巨噬细胞或S-100(+)树突状细胞，尤其是在急性和亚急性阶段的内膜中。除1例病例外，所有病例的内膜中均可见携带人类白细胞抗原-D区（HLA-DR）抗原的巨噬细胞和树突状细胞浸润。免疫球蛋白G、A和M（IgG、IgA、IgM）以及补体因子3d和4c（C3d、C4c）沿内弹性膜沉积。
血栓闭塞性脉管炎严格来说是一种动脉内膜炎，由T细胞介导的细胞免疫以及与内膜中巨噬细胞或树突状细胞激活相关的B细胞介导的体液免疫引发。
