Section of Endodontics, Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Int Endod J. 2024 Dec;57(12):1829-1847. doi: 10.1111/iej.14138. Epub 2024 Sep 2.
To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone-beam computed tomography.
Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients' age, gender and clinical characteristics were obtained from treatment records. A cone-beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno-expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann-Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman's correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score.
Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p < .001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p = .007, r = .262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p = .002, r = .306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p < .001, r = .453), whereas the negative correlation was observed for radicular cysts (p < .001, r = -.471).
Periapical granulomas are characterized by a M2-dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma.
通过免疫组织化学分析评估根尖囊肿和根尖肉芽肿中的 M1 和 M2 巨噬细胞极化，并通过锥形束 CT 评估巨噬细胞极化与组织病理学诊断、临床特征和病变体积之间的相关性。
对诊断为根尖囊肿（n=52）和根尖肉芽肿（n=51）的根尖活检进行免疫组织化学分析。纳入有根尖病变但无根管治疗史的牙齿（原发性病变）和根管治疗后仍存在病变的牙齿（持续性病变）。从治疗记录中获取病理诊断、患者年龄、性别和临床特征。根据病变体积，为每个根尖病变分配锥形束 CT 根尖体积指数（CBCTPAVI）评分。定量测定 CD68 和 CD163 的免疫表达。采用 CD68/CD163 比值表示 M1 或 M2 巨噬细胞极化。采用曼-惠特尼 U 检验比较根尖囊肿和根尖肉芽肿组之间的 CD68/CD163 比值差异。采用 Spearman 相关检验评估 CD68/CD163 比值与病变体积和 CBCTPAVI 评分之间的相关性。
根尖囊肿和根尖肉芽肿的 CD68/CD163 中位数分别为 2.05（IQR=1.33）和 1.26（IQR=0.81）。根尖囊肿的 CD68/CD163 比值明显更高（p<0.001）。相比之下，根尖肉芽肿的 CD68/CD163 比值明显更低。较大的病变具有更高的 CD68/CD163 比值，而较小的病变具有更低的 CD68/CD163 比值（p=0.007，r=0.262）。CD68/CD163 比值与整体根尖病变的 CBCTPAVI 评分显著相关（p=0.002，r=0.306）。较大病变中较高的 CD68/CD163 比值表明 M1 极化程度高于较小病变。关于病理诊断，根尖肉芽肿的 CBCTPAVI 评分与 CD68/CD163 比值呈显著正相关（p<0.001，r=0.453），而根尖囊肿则呈显著负相关（p<0.001，r=-0.471）。
根尖肉芽肿以 M2 占优势的巨噬细胞极化为主，而根尖囊肿则具有明显更高的 M1 巨噬细胞。更高程度的 M1 巨噬细胞极化与整体根尖病变和根尖肉芽肿的更大体积和更高 CBCTPAVI 评分显著相关。
