Takahara Miki
Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College, Asahikawa, Hokkaido, Japan.
Adv Otorhinolaryngol. 2011;72:86-8. doi: 10.1159/000324618. Epub 2011 Aug 18.
Palmoplantar pustulosis (PPP) is famous for causing typical tonsillar focal diseases. Clinical improvement of PPP rash after tonsillectomy was seen in 109 (94%) of 116 patients by subjective self-assessment, and 52 (88%) of 59 patients by objective Palmoplantar Pustulosis Area and Severity Index (PPPASI) scoring. Flow-cytometric analyses revealed that expression of activation markers (CD25 and HLA) class II increased on tonsillar T cells from PPP and IgAN patients. Moreover, expressions of skin-homing receptors (CLA and CCR6) increased on tonsillar T cells from PPP patients. In addition, the expressions were enhanced by stimulation of indigenous bacteria. Moreover, those expressions also increased in peripheral T cells, and decreased after tonsillectomy. Immunohistchemical analyses revealed that the ligands of those receptors (E-selectin and chemokine ligand 20) were expressed in lesions of skin. On the basis of our findings, migration of tonsillar T cells on which several homing receptors express by hyperimmune response against indigenous bacteria have a critical role in the pathogenesis of tonsillar focal diseases.
掌跖脓疱病（PPP）以引发典型的扁桃体局灶性疾病而闻名。在116例患者中，通过主观自我评估，109例（94%）患者在扁桃体切除术后掌跖脓疱病皮疹有临床改善；通过客观的掌跖脓疱病面积和严重程度指数（PPPASI）评分，59例患者中有52例（88%）有改善。流式细胞术分析显示，PPP患者和IgA肾病患者扁桃体T细胞上激活标志物（CD25和HLA）II类的表达增加。此外，PPP患者扁桃体T细胞上皮肤归巢受体（CLA和CCR6）的表达增加。此外，这些表达通过本土细菌的刺激而增强。而且，这些表达在外周血T细胞中也增加，扁桃体切除术后则降低。免疫组织化学分析显示，这些受体的配体（E-选择素和趋化因子配体20）在皮肤病变中表达。基于我们的研究结果，因对本土细菌的超敏反应而表达多种归巢受体的扁桃体T细胞的迁移在扁桃体局灶性疾病的发病机制中起关键作用。
