Tiemann M, Asbeck R, Wacker H H
Institut für Hämatopathologie, Christian Albrechts Universität, Kiel.
Verh Dtsch Ges Pathol. 1996;80:169-77.
With the establishment of the MALT concept in immunology it became obvious that B cells play an important role in the autoimmune diseases of the MALT. We immunophenotyped the intraepithelial B cells occurring in Hashimoto's disease, Sjögren's syndrome and Helicobacter pylori-associated gastritis and looked for clonal T-cell receptor gamma chains (TCR-gamma) and immunoglobulin heavy chains (JH). Immunophenotypically, we identified predominantly monocytoid B cells as the effector cells in the salivary glands of patients with Sjögren's syndrome, whereas in the thyroid and stomach the effector cells were marginal zone cells. Polyclonal rearrangements were found in 11/25 patients with Sjögren's syndrome, 23/40 patients with Hashimoto's disease and 19/24 patients with gastritis. Accordingly, 14 of the patients with Sjögren's syndrome, 17 of the patients with Hashimoto's disease and 5 of the patients with gastritis showed monoclonal rearrangements. Immunohistochemically, all patients with clonal rearrangements were found to have lymphoepithelial lesions. In these patients a transition to a low grade MALT lymphoma could be diagnosed. From these results we can conclude that in these two autoimmune diseases clonal rearrangements must be considered at least potentially malignant and that intraepithelial B cells should probably be considered the promoters of autoimmune diseases and of the development of primary extranodal B-cell lymphomas.
随着黏膜相关淋巴组织（MALT）概念在免疫学中的确立，很明显B细胞在MALT的自身免疫性疾病中发挥着重要作用。我们对桥本氏病、干燥综合征和幽门螺杆菌相关性胃炎中出现的上皮内B细胞进行了免疫表型分析，并寻找克隆性T细胞受体γ链（TCR-γ）和免疫球蛋白重链（JH）。在免疫表型上，我们在干燥综合征患者的唾液腺中主要鉴定出单核样B细胞为效应细胞，而在甲状腺和胃中效应细胞为边缘区细胞。在25例干燥综合征患者中有11例、40例桥本氏病患者中有23例以及24例胃炎患者中有19例发现多克隆重排。相应地，干燥综合征患者中有14例、桥本氏病患者中有17例以及胃炎患者中有5例显示单克隆重排。免疫组织化学检查发现，所有有克隆性重排的患者均有淋巴上皮病变。在这些患者中可诊断为向低级别MALT淋巴瘤转变。从这些结果我们可以得出结论，在这两种自身免疫性疾病中，克隆性重排至少应被视为具有潜在恶性，并且上皮内B细胞可能应被视为自身免疫性疾病以及原发性结外B细胞淋巴瘤发生的推动者。
