Babál P, Brozman M, Jakubovský J, Basset F, Jány Z
School of Medicine, Comenius University, Bratislava.
Czech Med. 1989;12(4):193-215.
Periapical granulomas have been investigated histologically, immunohistologically using polyclonal and monoclonal antibodies, as well as electronmicroscopically. Lesions were formed by inflammatory granulation tissue frequently with foci of purulent exudation and fibrosis. Most numerous were plasma cells usually in cellular regions of the granulation tissue where they were tightly pressed. Of other cellular types were numerous lymphocytes, fibroblasts, less frequent were macrophages, scattered granulocytes and mast cells. More than a half of the plasma cells were IgG positive, about 20% IgA positive, up to 10% IgM, rarely IgE and sporadically IgD positive cells. In the vascular walls and their surrounding as well as in the phagocytes fine granular to granular positivities of C3 and C4 components of the complement were present. The majority of lymphocytes beared markers of T lymphocytes of which the T-suppressor markedly prevailed over the T-helper lymphocytes. In electron microscopy the plasma cells were most frequent. They were usually close to each other, sometimes with a disintegrated cytoplasmic membrane and non-damaged organelles being free around the nucleus. Mast cells were numerous and did not show any signs of marked degranulation. Rich production of immunoglobulins as well as the presence of IgG and IgM positive material in phagocytes, and the presence of positivities of the C3 and C4 components of the complement in the surrounding of the vessels and in phagocytes on the other hand supported the presumption that immune complexes participate in the pathogenesis of periapical granulomas. In spite of the presence of the IgE producing cells the morphological picture of mast cells did not suggest the presence of anaphylactic reaction in periapical lesions. Diffuse distribution of T lymphocytes, moreover with the prevalence of T-suppressor/cytotoxic over T-helper lymphocytes and not numerous macrophages in the inflammatory infiltrates did not suggest the participation of a typical cell-mediated immunity reaction in the development of periapical granulomas. Numerous T-suppressor/cytotoxic lymphocytes and low numbers of macrophages can be important factors of the chronicity of periapical inflammatory diseases.
已通过组织学、使用多克隆和单克隆抗体的免疫组织化学以及电子显微镜对根尖肉芽肿进行了研究。病变由炎症性肉芽组织形成，常伴有脓性渗出和纤维化灶。数量最多的是浆细胞，通常位于肉芽组织的细胞区域，它们紧密排列。其他细胞类型中淋巴细胞数量众多，还有成纤维细胞，巨噬细胞、散在的粒细胞和肥大细胞较少见。超过一半的浆细胞呈IgG阳性，约20%呈IgA阳性，高达10%呈IgM阳性，很少有IgE阳性细胞，偶尔有IgD阳性细胞。在血管壁及其周围以及吞噬细胞中，补体的C3和C4成分呈细颗粒状至颗粒状阳性。大多数淋巴细胞带有T淋巴细胞标志物，其中T抑制细胞明显多于T辅助淋巴细胞。在电子显微镜下，浆细胞最为常见。它们通常彼此靠近，有时细胞质膜解体，细胞核周围有未受损的细胞器游离。肥大细胞数量众多，未显示出明显脱颗粒的迹象。另一方面，免疫球蛋白的丰富产生以及吞噬细胞中IgG和IgM阳性物质的存在，以及血管周围和吞噬细胞中补体C3和C4成分的阳性存在，支持了免疫复合物参与根尖肉芽肿发病机制的推测。尽管存在产生IgE的细胞，但肥大细胞的形态学表现并未提示根尖病变中存在过敏反应。T淋巴细胞的弥漫性分布，而且在炎症浸润中T抑制/细胞毒性细胞多于T辅助淋巴细胞且巨噬细胞数量不多，这并不提示典型的细胞介导免疫反应参与根尖肉芽肿的发生发展。大量的T抑制/细胞毒性淋巴细胞和少量的巨噬细胞可能是根尖炎性疾病慢性化的重要因素。
