Caris Research Institute, Irving, Texas, USA.
J Clin Pathol. 2010 Nov;63(11):999-1001. doi: 10.1136/jcp.2010.081232. Epub 2010 Oct 5.
To investigate the presence of IgG4+ plasma cells in gastric mucosal biopsy samples from patients with atrophic gastritis (AG) and a history of pernicious anaemia (PA) (AG+PA+).
Gastric mucosal biopsy specimens from 46 patients with AG+PA+ were investigated. As controls, we evaluated specimens from patients with AG but no history of PA (AG+ PA-) (n=25), normal histology (n=25), mild chronic inactive gastritis (MCIG) (n=25) or Helicobacter pylori gastritis (HP) (n=25). IgG4+ plasma cells were detected by two immunohistochemical methods: (1) using a monoclonal antibody, the average of the three most cellular high-power fields was counted in areas with the highest density of IgG4+ plasma cells; (2) using a dual-chromagen stain for both IgG4 and CD138 (plasma cell marker), the number of IgG4+ cells per 200 CD138+ plasma cells was counted. The latter was used to ensure that the number of IgG4+ cells was not simply related to the degree of inflammation (density of plasma cells).
Identical results were obtained with the two staining methods. Increased numbers of IgG4+ plasma cells were present in 37% of patients with AG+PA+, but in none with AG+PA-, MCIG, HP or normal gastric biopsy results (100% specific, p=0.0001).
IgG4+ plasma cells may play a role in the pathogenesis of PA and may be a useful marker for its diagnosis.
研究伴有恶性贫血（PA）病史的萎缩性胃炎（AG）患者胃黏膜活检标本中 IgG4+浆细胞的存在情况（AG+PA+）。
对 46 例 AG+PA+患者的胃黏膜活检标本进行研究。作为对照，我们评估了无 PA 病史的 AG 患者（AG+PA-）（n=25）、正常组织学（n=25）、轻度慢性非活动性胃炎（MCIG）（n=25）或幽门螺杆菌胃炎（HP）（n=25）的标本。通过两种免疫组织化学方法检测 IgG4+浆细胞：（1）使用单克隆抗体，在 IgG4+浆细胞密度最高的区域中，计数三个最具细胞性的高倍视野的平均值；（2）使用双重染色法同时检测 IgG4 和 CD138（浆细胞标志物），计算每 200 个 CD138+浆细胞中的 IgG4+细胞数。后一种方法用于确保 IgG4+细胞的数量与炎症程度（浆细胞密度）无关。
两种染色方法均得到相同的结果。在 37%的 AG+PA+患者中存在更多数量的 IgG4+浆细胞，但在 AG+PA-、MCIG、HP 或正常胃活检结果中均未发现（特异性 100%，p=0.0001）。
IgG4+浆细胞可能在 PA 的发病机制中起作用，并且可能是其诊断的有用标志物。
