Girolomoni G, Pincelli C, Zambruno G, Andreani M, Giardini C, Lucarelli G, Giannetti A
Clinica Dermatologica, Università di Modena, Italy.
J Dermatol. 1991 Jun;18(6):314-23. doi: 10.1111/j.1346-8138.1991.tb03091.x.
Graft-versus-host disease (GVHD) is an immunologically mediated disease occurring most frequently after allogeneic bone marrow transplantation. The aim of this study was to evaluate the contribution of immunohistochemistry in the diagnosis of cutaneous GVHD. Patients transplanted for either leukemia or beta-thalassemia were included in the study. Skin lesions of acute and chronic GVHD were examined both by direct immunofluorescence to detect immunoglobulin deposits and by an avidin-biotin-peroxidase complex technique to evaluate the inflammatory cell infiltrate. Epidermal and dermal fluorescent bodies (IgG and IgM) were frequently found in both acute and chronic GVHD. Most of the infiltrating cells were CD3+ T lymphocytes, with CD8+ cells representing the major cell population invading the epidermis both in acute GVHD and in chronic lichenoid GVHD. A small proportion of the dermal cells were CD14+ macrophages; no B cells were detected. HLA-DR, but not HLA-DQ antigens, were variably expressed by keratinocytes in all cases of acute GVHD and in chronic lichenoid GVHD. KL-1, a monoclonal antikeratin antibody specific for the 56.5 KD acidic polypeptide usually present in suprabasal keratinocytes, stained all epidermal layers, including the basal layer. Langerhans cells were dramatically reduced in number in the epidermis of both acute and chronic lichenoid GVHD. It is concluded that immunohistologic analysis may be supportive in the diagnosis of acute and early chronic lichenoid cutaneous GVHD.
移植物抗宿主病（GVHD）是一种免疫介导性疾病，最常发生于异基因骨髓移植后。本研究的目的是评估免疫组织化学在皮肤GVHD诊断中的作用。研究纳入了因白血病或β地中海贫血而接受移植的患者。采用直接免疫荧光法检测免疫球蛋白沉积，采用抗生物素蛋白-生物素-过氧化物酶复合物技术评估炎性细胞浸润，对急性和慢性GVHD的皮肤病变进行检查。在急性和慢性GVHD中均经常发现表皮和真皮荧光小体（IgG和IgM）。大多数浸润细胞为CD3+T淋巴细胞，在急性GVHD和慢性苔藓样GVHD中，CD8+细胞均为侵入表皮的主要细胞群。一小部分真皮细胞为CD14+巨噬细胞；未检测到B细胞。在所有急性GVHD和慢性苔藓样GVHD病例中，角质形成细胞均不同程度地表达HLA-DR抗原，但不表达HLA-DQ抗原。KL-1是一种针对通常存在于基底上层角质形成细胞中的56.5KD酸性多肽的单克隆抗角蛋白抗体，可对包括基底层在内的所有表皮层进行染色。在急性和慢性苔藓样GVHD的表皮中，朗格汉斯细胞数量均显著减少。结论是免疫组织学分析可能有助于急性和早期慢性苔藓样皮肤GVHD的诊断。
