Okada T, Sakamoto T, Ishibashi T, Inomata H
Department of Ophthalmology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Graefes Arch Clin Exp Ophthalmol. 1996 Jun;234(6):359-63. doi: 10.1007/BF00190711.
Vogt-Koyanagi-Harada disease (VKH) consists of uveitis with associated non-ocular symptoms, such as vitiligo or central nervous system disorders. A cell-mediated immune disorder is believed to play an important role in VKH; however, the skin lesion has not been well studied. Therefore, for this study, we examined the skin of a 56-year-old Japanese man with Vogt-Koyanagi-Harada disease (VKH).
Skin biopsy specimens from the patient's vitiligo were obtained 1 month after the onset of ocular symptoms. Immunohistochemical analysis of the specimens study was performed using the following monoclonal antibodies: anti-T cell, anti-B cell, anti-major histocompatibility complex class II (HLA-DR), anti-T helper/inducer (CD4), and anti-T suppressor/ cytotoxic lymphocytes (CD8).
Histopathologic analysis revealed mononuclear cell infiltration of the slightly edematous dermis, especially surrounding the hair follicles and sweat glands. Melaninladen cells in the epidermis were partially lost. The infiltrating mononuclear cells consisted primarily of T lymphocytes with a smaller number of B lymphocytes. Most showed expression of HLA-DR. CD4-positive lymphocytes were dominant over CD8-positive cells (3:1).
The results indicate that vitiligo of VKH is infiltrated by mostly activated helper/inducer lymphocytes and that cell-mediated immunity plays an important role in the pathogenesis of the dermal lesions of VKH as well.
伏格特-小柳-原田病（VKH）包括葡萄膜炎及相关的非眼部症状，如白癜风或中枢神经系统疾病。细胞介导的免疫紊乱被认为在VKH中起重要作用；然而，皮肤病变尚未得到充分研究。因此，在本研究中，我们检查了一名56岁患有伏格特-小柳-原田病（VKH）的日本男性的皮肤。
在眼部症状出现1个月后，获取患者白癜风部位的皮肤活检标本。使用以下单克隆抗体对标本进行免疫组织化学分析：抗T细胞、抗B细胞、抗主要组织相容性复合体II类（HLA-DR）、抗辅助性T/诱导性T细胞（CD4）和抗抑制性T/细胞毒性淋巴细胞（CD8）。
组织病理学分析显示，轻度水肿的真皮有单核细胞浸润，尤其是在毛囊和汗腺周围。表皮中含黑色素的细胞部分缺失。浸润的单核细胞主要由T淋巴细胞组成，B淋巴细胞数量较少。大多数细胞表达HLA-DR。CD4阳性淋巴细胞多于CD8阳性细胞（3:1）。
结果表明，VKH的白癜风主要由活化的辅助性/诱导性淋巴细胞浸润，细胞介导的免疫在VKH皮肤病变的发病机制中也起重要作用。
