Kissel J T, Riethman J L, Omerza J, Rammohan K W, Mendell J R
Department of Neurology, Ohio State University Hospital, Columbus.
Ann Neurol. 1989 Mar;25(3):291-7. doi: 10.1002/ana.410250314.
Quantitative immunohistochemical analyses were performed on 22 nerve biopsy specimens from patients with systemic vasculitis (n = 14) or isolated vasculitis of peripheral nerve (n = 8). In the vascular lesions the cellular infiltrates were composed primarily of T cells (71 +/- 18%; mean +/- SD) and macrophages (27 +/- 17%), and the majority of the T cells (65 +/- 20%) were cytotoxic/suppressor CD8 cells. B cells were seen in only 4 cases and constituted less than 2% of all cells. Natural killer cells and polymorphonuclear leukocytes were rare, and a leukocytoclastic response was not observed. Fourteen biopsy specimens had vascular deposits of immunoglobulins G and M and complement components C3 and C5b-9 membrane attack complex, while 4 had only the latter. The fact that the immunoglobulin and complement deposits were seen only in vessels that had corresponding intense cellular infiltrates suggests an important, but perhaps not primary, role for immune complexes in causing the vascular lesions. Statistical analysis revealed striking similarities in the lesions of patients with isolated nerve vasculitis and those with systemic vasculitides, suggesting a common pathogenic mechanism. Collectively, our observations suggest an important role for a T-cell-dependent cell-mediated process as a primary mechanism of vessel injury in peripheral nerve vasculitis.
对22例系统性血管炎患者（n = 14）或孤立性周围神经血管炎患者（n = 8）的神经活检标本进行了定量免疫组织化学分析。在血管病变中，细胞浸润主要由T细胞（71±18%；平均值±标准差）和巨噬细胞（27±17%）组成，并且大多数T细胞（65±20%）是细胞毒性/抑制性CD8细胞。仅在4例中观察到B细胞，且B细胞占所有细胞的比例不到2%。自然杀伤细胞和多形核白细胞很少见，未观察到白细胞破碎反应。14例活检标本有免疫球蛋白G和M以及补体成分C3和C5b - 9膜攻击复合物的血管沉积，而4例仅存在后者。免疫球蛋白和补体沉积仅见于有相应强烈细胞浸润的血管这一事实表明免疫复合物在引起血管病变中起重要作用，但可能不是主要作用。统计分析显示，孤立性神经血管炎患者和系统性血管炎患者的病变有显著相似性，提示存在共同的致病机制。总体而言，我们的观察结果表明，T细胞依赖性细胞介导过程作为周围神经血管炎血管损伤的主要机制起重要作用。
