本文選題：炎癥性腸病 + 免疫細(xì)胞��； 參考：《中國人民解放軍醫(yī)學(xué)院》2014年博士論文

【摘要】：【目的】炎癥性腸病(IBD)是一種常見的慢性腸道病，主要包括潰瘍性結(jié)腸炎(UC)和克羅恩病(CD)。臨床對UC及CD的確診依靠腸鏡及病理活檢,但是病理醫(yī)生依靠腸鏡取到的標(biāo)本很難給出明確的診斷,這主要是由于缺乏有效可行的診斷依據(jù)和鑒別診斷要點(diǎn)。IBD的確切病因還不清楚，但是免疫因素日益受到人們的重視。目前為止，IBD粘膜免疫細(xì)胞的形態(tài)學(xué)變化規(guī)律很少有人研究。我們希望通過對IBD腸粘膜內(nèi)免疫細(xì)胞種類與分布的研究,尋找新的鑒別診斷線索。 【方法】選取病例，，參照2012年中華醫(yī)學(xué)會消化病學(xué)分會新制定的診斷標(biāo)準(zhǔn)，結(jié)合臨床病史及內(nèi)窺鏡下表現(xiàn)重新做出診斷。最后確定UC30例，CD26例，另外選取10例正常腸粘膜作為對照組。所有病例均重新HE染色及應(yīng)用兩步法加做13項(xiàng)免疫組化染色（CD1a、CD3、CD5、CD20、CD21、CD43、CD68、CD79α、CD138、CD163、S-100、PC、Ki-67）。所有切片均掃描進(jìn)入優(yōu)納ISCAN系統(tǒng)進(jìn)行半定量分析。統(tǒng)計(jì)學(xué)方法應(yīng)用SPSS13.0統(tǒng)計(jì)軟件對數(shù)據(jù)進(jìn)行分析。免疫組化染色還進(jìn)行了定性分析，分為弱（+）、中（++）、強(qiáng)（+++）三級。 【結(jié)果】CD與UC的HE染色上的細(xì)胞數(shù)比較沒有統(tǒng)計(jì)學(xué)意義，但UC及CD的細(xì)胞數(shù)與正常對照組相比均具有顯著的統(tǒng)計(jì)學(xué)意義（p0.01）。 組織細(xì)胞染色： CD1a在正常腸粘膜及UC內(nèi)幾乎沒有表達(dá)， CD統(tǒng)計(jì)分析比較與正常對照組及UC均有統(tǒng)計(jì)學(xué)意義(p0.05)。CD21三者的差異可能是其它細(xì)胞著色的結(jié)果，在組織學(xué)上的鑒別診斷意義不大。S-100染色陽性的細(xì)胞種類很多，S-100三組的組間比較均具有統(tǒng)計(jì)學(xué)意義（p0.05）。CD68的UC組與正常對照組比較不具有統(tǒng)計(jì)學(xué)意義p0.05）。而CD組的陽性細(xì)胞數(shù)少于正常對照組和UC組，與UC及正常對照組比較均具有統(tǒng)計(jì)學(xué)意義（p0.05）。CD163染色時CD與正常對照組比較具有統(tǒng)計(jì)學(xué)意義（p0.05）。 T淋巴細(xì)胞染色： CD3在UC組固有層內(nèi)分布密集，并與血管緊密接觸。CD的CD3陽性細(xì)胞散在。三組的組間比較均具有統(tǒng)計(jì)學(xué)意義（p0.05）。CD5的陽性細(xì)胞數(shù)量比CD3要少，UC組CD5的陽性細(xì)胞分布與CD3大致相同。CD的CD5陽性細(xì)胞的分布要比CD3稍少一些。三組的組間比較也都具有統(tǒng)計(jì)學(xué)意義（p0.05）。正常對照組CD43固有層內(nèi)的分布要比CD3密集。UC組固有層內(nèi)密集分布。CD：CD43固有層內(nèi)細(xì)胞密集CD43分子在三組的組間比較均具有統(tǒng)計(jì)學(xué)意義（p0.05）。 B淋巴細(xì)胞染色： 正常對照組CD20粘膜固有層內(nèi)只有個別陽性細(xì)胞。UC組CD20在固有層內(nèi)散在個別陽性細(xì)胞。CD：CD20固有層內(nèi)幾乎（-）CD20在三組之間的組間比較結(jié)果均具有統(tǒng)計(jì)學(xué)意義（p0.05）。正常對照組CD79α在粘膜固有層內(nèi)可見陽性細(xì)胞。UC組CD79α在固有層內(nèi)密集分布。CD：CD79α固有層內(nèi)散在分布。三組的組間比較均具有統(tǒng)計(jì)學(xué)意義（p0.05）。正常對照組CD138固有層內(nèi)陽性細(xì)胞分布較少。UC組CD138在較淺的固有層++。CD組CD138在已經(jīng)形成肉芽腫的區(qū)域（++），上皮細(xì)胞之間（+）。三組的組間比較具有統(tǒng)計(jì)學(xué)意義（p0.05）。正常對照組PC固有層內(nèi)數(shù)量較多。UC組固有層內(nèi)大量陽性細(xì)胞。CD組PC大片陽性細(xì)胞（++）。三組的組間比較均具有統(tǒng)計(jì)學(xué)意義（p0.05）。 增殖活性比較： 正常對照組Ki67只有個別上皮細(xì)胞陽性。UC：Ki67：腺體及濾泡中心區(qū)++，固有層++，濾泡周邊-。CD：Ki67陽性細(xì)胞約占1-2%。三組的組間比較均具有統(tǒng)計(jì)學(xué)意義(p0.05)。 【結(jié)論】可以通過多種免疫組化染色結(jié)果綜合判斷IBD的免疫狀態(tài)及對UC和CD進(jìn)行鑒別診斷。CD1a:UC(-),CD(+);Ki67UC(+10%),CD(+1-2%);S-100、CD3、CD20的陽性細(xì)胞數(shù)UC〉CD，細(xì)胞分布不同；PC的陽性細(xì)胞數(shù)UCCD,細(xì)胞分布不同。其他抗體可以作為輔助診斷手段。
[Abstract]:[Objective] inflammatory bowel disease (IBD) is a common chronic intestinal disease, mainly including ulcerative colitis (UC) and Crohn's disease (CD). The diagnosis of UC and CD depends on enteroscopy and pathological biopsy, but the pathologists rely on enteroscopy for a difficult to give a clear diagnosis. This is mainly due to the lack of effective and feasible diagnostic basis. The exact cause of the differential diagnosis of.IBD is not clear, but the immune factors are getting more and more attention. So far, the morphological changes of IBD mucosal immune cells are rarely studied. We hope to find new differential diagnostic clues by the study of the species and distribution of immune cells in the intestinal mucosa of IBD.
[Methods] to select the cases and to make a new diagnosis according to the new diagnostic criteria of the Chinese Medical Association in 2012, combined with the clinical history and the manifestations under endoscopy. Finally, UC30 cases, CD26 cases, and 10 normal intestinal mucosa were selected as the control group. All cases were re HE staining and 13 immunization groups were added by the two step method. Chemical staining (CD1a, CD3, CD5, CD20, CD21, CD43, CD68, CD79 alpha, CD138, CD163, S-100, PC). All slices were scanned into the semiquantitative analysis. Statistical methods were used to analyze the data. Immunohistochemical staining was also carried out qualitative analysis, divided into weak (+), medium (+ +), and strong (+ + +) three levels.
[results] the number of cells on HE staining of CD and UC was not statistically significant, but the number of cells in UC and CD had significant statistical significance compared with that of the normal control group (P0.01).
Histiocytic staining:
There was almost no expression of CD1a in normal intestinal mucosa and UC. The statistical analysis of CD compared with normal control group and UC (P0.05).CD21 three may be the result of other cell coloring. In histological diagnosis, there are many different types of positive cells with no.S-100 staining, and all of the groups of S-100 three have the same group. The UC group of.CD68 (P0.05) had no statistical significance compared with the normal control group, but the number of positive cells in the CD group was less than that of the normal control group and the UC group. The ratio of CD to the normal control group was statistically significant (P0.05) compared with the normal control group (P0.05) and the normal control group (P0.05).
T lymphocyte staining:
The distribution of CD3 in the lamina propria of UC was dense, and the CD3 positive cells with close contact with the blood vessels were scattered in the three groups. The number of positive cells in the three groups was less than that of CD3, and the distribution of the positive cells of CD5 in UC group and CD3 was slightly smaller than that of CD3. The comparison between groups of the three groups was compared. There was also statistical significance (P0.05). The distribution of CD43 propria in the normal control group was more significant than that of the dense distribution of.CD:CD43 proprs in the lamina propria of CD3 intensive.UC group (P0.05) in the three groups.
B lymphocyte staining:
In the lamina propria of the normal control group, only a few positive cells in the lamina propria.UC CD20 scattered within the lamina propria of the positive cell.CD:CD20 propria almost (-) CD20 between the three groups was statistically significant (P0.05). The normal control group of CD79 alpha in the lamina propria.UC group CD79 alpha in the lamina propria The distribution of internal dense distribution of.CD:CD79 alpha propri was distributed. The comparison between the three groups was statistically significant (P0.05). The positive cells in the CD138 lamina of the normal control group were less distributed in the.UC group CD138 in the shallow lamina propria ++.CD group CD138 in the granulomatous region (+ +) and the upper cutaneous cells (+). The comparison of the three groups was statistically significant. The study significance (P0.05). In the normal control group, the number of PC proprs in the normal control group was large in the propria of.UC group, and a large number of positive cells in the.CD group were positive cells (+ +) of PC blockbuster. The comparison between the three groups was statistically significant (P0.05).
The comparison of proliferation activity:
In the normal control group, Ki67 was only.UC:Ki67 positive in individual epithelial cells: the gland and the central region of follicular + +, propria + +, and the -.CD:Ki67 positive cells around the follicular group accounted for a statistically significant difference between the groups of 1-2%. three groups (P0.05).
[Conclusion] the immunological status of IBD and the differential diagnosis of.CD1a:UC (-), CD (+), CD (+), Ki67UC (+10%), CD (+1-2%), S-100, CD3, CD20 cells are different, and the cell distribution is different, and the number of positive cells is different. Other antibodies can be used as auxiliary diagnosis. Means.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R574

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