中枢神经脱髓鞘性疾病病理组织学与免疫组化研究

目的　研究中枢神经脱髓鞘性疾病的病理组织学及免疫反应。方法　多发性硬化（ＭＳ）２ 例，视神经脊髓炎（ＤＤ）、急性播散性脑炎（ＡＤＥ）及急性出血性白质脑病（ＡＨＬＥ）各１ 例进行脑及脊髓病理组织学观察，以抗ＩｇＧ、ＩｇＡ、ＩｇＭ、Ｇ３ 补体、ＣＤ２０、ＣＤ４５ＲＯ抗体组化染色。结果　各种脱髓鞘性疾病脑部以白质脱鞘为主，脊髓则灰白质同时受累，坏死常见。小血管周围有不同程度炎细胞浸润。组化染色见较多Ｔ细胞浸润，ＩｇＧ、ＩｇＡ、ＩｇＭ、Ｃ３ 补体多见于细胞内，主要是巨噬细胞，亦见于星形细胞、浆细胞，在ＡＨＬＥ坏变血管壁、血管周围间隙、软膜及室管膜沉积较多。结论　ＭＳ与ＤＤ病变性质相同而部位有异，ＡＨＬＥ突出表现为小血管壁坏死、灶性出血，ＡＤＥ介于二者之间。脱髓鞘性疾病与免疫反应密切相关，各型间免疫反应类型与程度有所不同。星形胶质细胞在脱髓鞘性疾病免疫应答中可能发挥了重要作用。

A Histopathological and Immunohistochemical Studies in Demyelinating Diseases

Objective To investigate the histopathology and immunohisto chemistry in demyelinating diseases of central nervous system. Methods The brains and spinal cords for 5 cases, including multiple sclerosis (MS) in 2, Devic disease (DD) in 1, acute disseminated encephalomyelitis (ADE) in 1 and acute haemorrhagic leacoencephalilis (AHLE) in 1 were studied with routine pathologic and immunohistochemical procedures Results The lessions were involved mainly at white matter in the brains, but in spinal cords the gray substance had joined white matter with necrosis in all of the cases. The small vascular were damaged. The inflammatory cells were found in the perivastcular space with mainly T lymphocytes infiltration. The most of IgG, IgA, IgM and C3 were intracellular, located in macrophages, astrocytes and plasma cells while infiltrating the vascular walls pia mater and ependyma with necrosis . Conclusion The involved areas varied with MS and DD, but some necrosis of small vascular and focal hemorrhage were characteristic in AHLE. The pathologic changes in ADE were between MS and AHLE. It was suggested that demylinating diseases were related with immunologic process, but the degree of response varied with different types of demyelinating diseases. Astrocyles might relate to immulogic process in demylinating diseases.