Matsuyama H, Yamanaka N
Department of Otolaryngology-Head and Neck Surgery, Sapporo Medical College.
Nihon Jibiinkoka Gakkai Kaiho. 1990 Jan;93(1):6-17. doi: 10.3950/jibiinkoka.93.6.
The purpose of this study was to clarify the mechanism of tonsillar focal infections such as pustulosis palmaris et plantaris (PPP), especially the role of tonsil on it. In 88 cases of various tonsillar diseases, i.e., PPP, chronic tonsillitis, and sleep apnea syndrome, distribution of immunocompetent cells, i.e., B cells having various immunoglobulin isotypes (IgG, IgM, IgA, IgD, IgE, IgA1, and IgA2) on their surfaces and T cell subsets, helper/inducer (CD4+) T cell and suppressor/cytotoxic (CD8+) T cell were investigated immunohistologically using monoclonal antibodies and ABC method. The proportion of the immunocompetent cells in four anatomical sites in tonsil (germinal center, mantle zone, interfollicular area, and subepithelial area) were quantitatively studied by the image analyzer (CUE-2, Olympus, USA) and compared among various age groups and among three groups of tonsillar diseases. The difference of immunocompetent cells in tonsils between the effective group (showing marked improvement of skin lesions of PPP after tonsillectomy) and the not-effective group (showing no improvement of skin lesions after tonsillectomy) was also investigated. The results were summarized as follows. 1) Every type of Ig-positive cells in tonsils was decreased in proportion to age, especially the changes of IgG-, IgM-, and IgD-positive cells were inversely proportional to age with statistical significance. On the other hand, changes to T cell subsets with age were smaller in comparison with those of Ig-positive cells, especially the proportion of CD4-positive cells showed almost no changes in accordance with age. 2) Eighty percent of cases with PPP were classified into the effective group, whereas only 20% of them into the not-effective group. 3) IgG-, IgM-, and IgD-positive cells in tonsils of PPP were found to be significantly increased in the effective group compared to the not-effective group. In addition, in the effective group, CD4-positive cells were significantly increased in the interfollicular area and the subepithelial area of the tonsil. These results indicate that the image analysis will be a breakthrough in quantitative study on the immunohistology of the tonsil and give us useful informations in terms of the mechanism of tonsillar focal infections, i.e., immunological abnormalities in tonsils may play one of the important roles in the pathogenesis of PPP.
本研究的目的是阐明掌跖脓疱病（PPP）等扁桃体局灶性感染的机制，尤其是扁桃体在其中的作用。在88例各种扁桃体疾病患者中，即PPP、慢性扁桃体炎和睡眠呼吸暂停综合征患者，使用单克隆抗体和ABC法，通过免疫组织学方法研究了免疫活性细胞的分布，即表面具有各种免疫球蛋白同种型（IgG、IgM、IgA、IgD、IgE、IgA1和IgA2）的B细胞以及T细胞亚群，辅助/诱导（CD4 +）T细胞和抑制/细胞毒性（CD8 +）T细胞。使用图像分析仪（CUE - 2，美国奥林巴斯公司）对扁桃体四个解剖部位（生发中心、套区、滤泡间区和上皮下区）的免疫活性细胞比例进行定量研究，并在不同年龄组和三组扁桃体疾病之间进行比较。还研究了有效组（扁桃体切除术后PPP皮肤病变明显改善）和无效组（扁桃体切除术后皮肤病变无改善）扁桃体中免疫活性细胞的差异。结果总结如下。1）扁桃体中各类Ig阳性细胞的比例随年龄下降，尤其是IgG、IgM和IgD阳性细胞的变化与年龄呈反比，具有统计学意义。另一方面，与Ig阳性细胞相比，T细胞亚群随年龄的变化较小，尤其是CD4阳性细胞的比例几乎不随年龄变化。2）80%的PPP病例被归类为有效组，而只有20%被归类为无效组。3）与无效组相比，有效组PPP患者扁桃体中的IgG、IgM和IgD阳性细胞显著增加。此外，在有效组中，扁桃体滤泡间区和上皮下区的CD4阳性细胞显著增加。这些结果表明，图像分析将成为扁桃体免疫组织学定量研究的一个突破，并为我们提供有关扁桃体局灶性感染机制的有用信息，即扁桃体中的免疫异常可能在PPP的发病机制中起重要作用之一。
