Matsumuro K, Izumo S, Umehara F, Osame M
Third Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
J Neurol Sci. 1994 Dec 20;127(2):170-8. doi: 10.1016/0022-510x(94)90070-1.
We undertook histological and immunopathological studies on biopsied sural nerves from 9 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). The diagnosis of CIDP was based on the research criteria proposed by the Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force. The nerve pathology in these patients comprised macrophage-associated active demyelination and subsequent remyelination of various proportions. The presence of T cells in the endoneurium correlated with activity of demyelination. An analysis of T cell subsets demonstrated that the number of CD8-positive cells predominated over that of CD4-positive ones. Infiltration of B cells, and depositions of immunoglobulin and complement were not seen. These observations suggest that a T cell-mediated process is of pathogenic significance in CIDP. Furthermore, a double immunofluorescence staining revealed that most HLA-DR antigen-positive cells in the nerves in which active demyelination was seen coexpressed a macrophage-specific determinant. Conversely, HLA-DR-positive Schwann cells were found in the nerves in which remyelination was predominant. The expression of HLA-DR antigen on Schwann cells might not play a pathogenic role in the active demyelination in CIDP.
我们对9例慢性炎症性脱髓鞘性多发性神经病（CIDP）患者的腓肠神经活检组织进行了组织学和免疫病理学研究。CIDP的诊断基于美国神经病学学会艾滋病特别工作组特设小组委员会提出的研究标准。这些患者的神经病理学表现为巨噬细胞相关的活动性脱髓鞘以及随后不同比例的髓鞘再生。神经内膜中T细胞的存在与脱髓鞘活动相关。T细胞亚群分析表明，CD8阳性细胞的数量多于CD4阳性细胞。未见B细胞浸润以及免疫球蛋白和补体沉积。这些观察结果提示，T细胞介导的过程在CIDP中具有致病意义。此外，双重免疫荧光染色显示，在出现活动性脱髓鞘的神经中，大多数HLA-DR抗原阳性细胞共表达巨噬细胞特异性决定簇。相反，在以髓鞘再生为主的神经中发现了HLA-DR阳性雪旺细胞。雪旺细胞上HLA-DR抗原的表达可能在CIDP的活动性脱髓鞘中不发挥致病作用。
