Dugan E, Modlin R L, Rea T H
Int J Lepr Other Mycobact Dis. 1985 Sep;53(3):404-9.
In an attempt to further define their immunopathogenesis, the cellular infiltrates of Mitsuda reactions were studied in situ using immunoperoxidase techniques and monoclonal antibodies. Lepromin A-elicited Mitsuda reactions from six patients with borderline tuberculoid leprosy (TT/BT or BT) and three healthy kindred and contacts of lepromatous patients were examined. In the dermis, cells bearing the Leu4 phenotype comprised a mean of 61% of the infiltrate; the Leu3a, 47%; the Leu2a, 17%; anti-IL-2, 0.2%; anti-Tac, 1.5%; and cells bearing the Ia phenotype were virtually universal; OKT6 positive cells were present. The Leu2 phenotype was sequestered to the periphery of epithelioid tubercules. In the epidermis, there were mild, focal lymphocytic infiltrates, hyperplasia of epidermal Langerhans' cells, and well-developed expression of Ia upon nucleated keratinocytes. These findings, when compared with those of a better-defined reaction, tuberculin, are further evidence that the Mitsuda response may be a delayed-type hypersensitivity phenomenon.
为了进一步明确其免疫发病机制，利用免疫过氧化物酶技术和单克隆抗体对麻风菌素反应的细胞浸润进行了原位研究。检测了6例界线类偏结核样型麻风（TT/BT或BT）患者以及3名麻风瘤患者的健康亲属和接触者的麻风菌素A引发的麻风菌素反应。在真皮中，表达Leu4表型的细胞平均占浸润细胞的61%；Leu3a表型的细胞占47%；Leu2a表型的细胞占17%；抗IL-2的细胞占0.2%；抗Tac的细胞占1.5%；表达Ia表型的细胞几乎普遍存在；OKT6阳性细胞也存在。Leu2表型的细胞聚集在上皮样结节的周边。在表皮中，有轻度的局灶性淋巴细胞浸润、表皮朗格汉斯细胞增生以及有核角质形成细胞上Ia的充分表达。与定义更明确的反应——结核菌素反应的结果相比，这些发现进一步证明麻风菌素反应可能是一种迟发型超敏反应现象。
