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目的临床上部分青年缺血性卒中患者血清免疫球蛋白E(immunoglobulin E,Ig E)增高,推测为脑血管炎,但缺乏病理学依据。文中旨在通过颞动脉活检组织病理学研究探讨该类患者血管病变的特点。方法对2013年1月至2015年8月间在南京军区南京总医院神经内科住院的32例病因不明的青年缺血性卒中患者颞动脉标本进行组织病理学检查,其中血清Ig E正常者(正常组)与增高者(增高组)各16例。通过HE染色观察炎症细胞浸润灶,甲苯胺蓝染色检测肥大细胞,免疫组化检测基质金属蛋白酶9(matrix metalloproteinase 9,MMP-9)、单核细胞趋化蛋白-1(Monocyte chemotaxis protein-1,MCP-1)和Ig E等表达。结果与血清Ig E正常组相比,增高组患者颞动脉血管壁炎症细胞浸润呈现出更高的发生率(62.5%vs12.5%,P<0.01),1例伴外膜纤维素性渗出及小灶坏死的标本也见于Ig E增高组。Ig E增高组颞动脉MCP-1的平均光密度值[(9.25±5.79)×10~(-5)]高于正常组[(4.41±2.87)×10-5],差异有统计学意义(P<0.01)。MMP-9的平均光密度值和内中膜厚度在血清Ig E增高组中均呈增加的倾向,但组间比较差异均无统计学意义(P>0.05)。2组间肥大细胞计数差异无统计学意义(P>0.05)。结论血清Ig E增高组患者颞动脉血管壁炎症细胞浸润、坏死反应和纤维素性渗出可能是血管炎的一种表现,推测MCP-1在病变过程中可能起到一定的作用。
Objective To investigate the clinical significance of serum immunoglobulin E (IgE) in some young patients with ischemic stroke, which is presumed to be cerebral vasculitis, but lack of pathological evidence. The aim of this paper is to investigate the characteristics of vascular lesions in these patients by histopathology of temporal artery biopsy. Methods Thirty-two patients with unidentified young ischemic stroke who were hospitalized in the Nanjing General Hospital of Nanjing Military Region from January 2013 to August 2015 were histopathologically examined for histopathology. Serum IgE was normal (normal Group) and increased (increased group) in 16 cases. Inflammatory cell infiltration was observed by HE staining. Mantle cells were detected by toluidine blue staining. The expressions of MMP-9, Monocyte chemotaxis protein-1 MCP-1) and Ig E expression. Results Compared with the normal IgE group, the infiltration of inflammatory cells in the temporal artery wall showed a higher incidence in the elevated group (62.5% vs 12.5%, P <0.01) Small necrosis of the specimen also found in IgE increased group. The mean optical density of MCP-1 in the temporal artery increased significantly in IgE group [(9.25 ± 5.79) × 10 -5] compared with that in the normal group [(4.41 ± 2.87) × 10-5], the difference was statistically significant ( P <0.01). The mean optical density of MMP-9 and intima-media thickness tended to increase in the serum IgE increased group, but there was no significant difference between the two groups (P> 0.05). There was no significant difference in mast cell count between the two groups (P> 0.05). Conclusions Inflammatory cell infiltration, necrotic reaction and fibrinous exudation of temporal artery wall may be a manifestation of vasculitis in patients with elevated serum IgE levels. It is speculated that MCP-1 may play a role in the pathological changes.