Kameyama Makoto, Chen Ko-Ron, Mukai Kiyoshi, Shimada Akira, Atsumi Yoshihito, Yanagimoto Shigeru
Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan.
J Hand Surg Am. 2013 Jul;38(7):1331-9. doi: 10.1016/j.jhsa.2013.03.049. Epub 2013 Jun 5.
To compare the histopathological findings of stenosing flexor tenosynovitis (SFTS) in diabetic patients with those in nondiabetic patients and to analyze the predominant characteristics of SFTS in diabetic patients by statistical methods.
We included 63 patients (63 specimens) who underwent excision of A1 pulleys for SFTS. A total of 38 patients (38 digits) were diabetic and 25 (25 digits) were nondiabetic. We obtained specimens from the proximal one-third of each A1 pulley and analyzed them by histological and immunohistochemical methods. After we identified the predominant histopathological characteristics of SFTS in patients with diabetes, we performed multiple logistic regression analysis to examine the possible associations between the histopathological characteristics and diabetes-related variables.
We divided histopathological findings into 3 types in both diabetic and nondiabetic groups. Types 1 and 2 showed fibrocartilage metaplasia including fibrocartilage-like cells surrounded by basophilic extracellular substances. Type 2 was characterized by the presence of granulation tissue in the middle layer, which was not recognized in type 1. The granulation tissue contained newly formed microvessels, stromal cells, a small number of inflammatory cells, and extracellular matrix that showed myxomatous degeneration. Type 3 showed a decrease in fibrocartilage-like cells with surrounding extracellular eosinophilic substances, which was similar to hyaline degeneration. The histopathological features of type 2 were found in 68% of the diabetic group and in 28% of the nondiabetic group. This difference was statistically significant. The findings of type 2 were significantly associated with the severity of diabetic retinopathy and hemoglobin A1c values in the diabetic group.
Type 2 findings were more frequent in the diabetic group than in the nondiabetic group. A pathomechanism to accelerate neovascularization and hypercellularity in the granulation tissue in the middle layer of A1 pulley may exist, especially in diabetic patients with severe retinopathy and poorly controlled hyperglycemia.
比较糖尿病患者与非糖尿病患者狭窄性屈指肌腱腱鞘炎（SFTS）的组织病理学表现，并通过统计学方法分析糖尿病患者SFTS的主要特征。
我们纳入了63例行A1滑车切除术治疗SFTS的患者（63个标本）。其中糖尿病患者38例（38指），非糖尿病患者25例（25指）。我们从每个A1滑车的近端三分之一处获取标本，并采用组织学和免疫组织化学方法进行分析。在确定糖尿病患者SFTS的主要组织病理学特征后，我们进行多因素logistic回归分析，以检验组织病理学特征与糖尿病相关变量之间的可能关联。
我们将糖尿病组和非糖尿病组的组织病理学表现分为3种类型。1型和2型表现为纤维软骨化生，包括被嗜碱性细胞外物质包围的纤维软骨样细胞。2型的特征是中层存在肉芽组织，1型中未发现。肉芽组织包含新形成的微血管、基质细胞少量炎性细胞以及表现为黏液样变性的细胞外基质。3型表现为纤维软骨样细胞减少，周围有嗜酸性细胞外物质，类似于透明变性。2型组织病理学特征在糖尿病组中占68%，在非糖尿病组中占28%。这种差异具有统计学意义。在糖尿病组中，2型表现与糖尿病视网膜病变的严重程度和糖化血红蛋白值显著相关。
2型表现在糖尿病组中比非糖尿病组更常见。可能存在一种加速A1滑车中层肉芽组织新生血管形成和细胞增多的发病机制，尤其是在患有严重视网膜病变和血糖控制不佳的糖尿病患者中。
