肾上腺髓质素在肾上腺疾病中的免疫组化研究

目的：应用免疫组织化学技术观察免疫反应性肾上腺髓质素（ir-ADM)在人正常肾上腺、良恶性肾上腺肿瘤及肾上腺皮质增生组织中的分布特点。方法：对人正常肾上腺皮质（n＝10)和髓质（n=10)、嗜铬细胞瘤（n=31)、原发性醛固酮增多症的肾上腺皮质腺瘤（n=13)和增生（n=9)、皮质醇增多症的肾上腺皮质腺瘤（n=12)、增生（n=10)和腺癌（n=4)、无功能肾上腺皮质腺癌组织（n=7)进行ir-ADM的免疫组化染色。结果：10例人正常肾上腺髓质组织均显示ir-ADM染色阳性;31例嗜铬细胞瘤组织中16例染色阳性,大部分嗜铬细胞瘤组织中的ir-ADM免疫组化染色强度低于正常肾上腺髓质组织（P＜0．01）。在嗜铬细胞瘤中阵发性高血压组阳性染色例数多于持续性高血压组（P＜0．05）;人正常肾上腺皮质及各组皮质病变组织中,ir-ADM免疫组化染色均为阴性。结论：ir-ADM在嗜铬细胞瘤组织中分布呈不均一性,可能与嗜铬细胞瘤患者血压表现的多样化有关,应进一步探讨ADM在嗜铬细胞瘤发病中的病理生理作用。

Immunohistochemical identification of adrenomedullin in adrenal diseases

OBJECTIVE: Adrenomedullin (ADM) is a hypotensive peptide isolated from human pheochromocytoma tissue. In order to identify the pathophysiological effects of ADM on the etiology of adrenal diseases which can induce hypertension, the localization of immunoreactive adrenomedullin (ir-ADM) in adrenal tissue of subjects with normal adrenal and patients with different adrenal diseases was investigated by means of immunohistochemical staining. METHODS: Peroxidase anti-peroxidase complex method was undertaken in the tissue of human adrenal cortex (n = 10) and medulla (n = 10)of subjects with normal adrenal, as well as in the tissue of pheochromocytoma (n = 31), primary aldosteronism including adrenocortical adenoma (n = 13) and hyperplasia (n = 9), Cushing's syndrome including adrenocortical adenoma (n = 12), hyperplasia (n = 10), carcinoma (n = 4) and non-functional adrenocortical carcinoma (n = 7). RESULTS: Positive immunohistochemical staining of ir-ADM was observed in all the cases of normal adrenal medulla and 16 of the 31 cases of pheochromocytoma. The intensity of immunohistochemical staining of ir-ADM in the majority of pheochromocytoma was lower than that in normal adrenal medulla (P < 0.01). The number of pheochromocytoma cases with positive staining in paroxysmal hypertensive group was higher than that in sustained hypertensive group (P < 0.05). Negative immunohistochemical staining was found in all the cases of normal human adrenal cortex, adrenocortical adenoma, hyperplasia and carcinoma. CONCLUSION: It is suggested that heterogeneous of localization of ir-ADM in pheochromocytoma tissue may be correlated to the diversity of blood pressure in patients with pheochromocytoma. The pathophysiological effects of ADM on the etiology of pheochromocytoma should be further investigated.