The Utility of C4d, C9, and Troponin T Immunohistochemistry in Acute Myocardial Infarction
The Utility of C4d, C9, and Troponin T Immunohistochemistry in Acute Myocardial Infarction
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DOI：
10.1043/1543-2165-134.2.256
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发表时间：
2010-02-01
影响因子：
4.6
通讯作者：
Normann, Sigurd J.
中科院分区：
文献类型：
--
作者：
Jenkins, Crystal P.;Cardona, Diana M.;Normann, Sigurd J.
背景：急性心肌梗死后补体通路的完全激活和参与。补体片段C4D是一个稳定的、共价结合的补体激活标志物。肌钙蛋白T是心肌细胞所特有的。目的：确定C4D、C9和肌钙蛋白T在坏死性心肌细胞中的特异性，并确定它们是否可用于描绘急性心肌梗死。设计：回顾26例尸检病例，共54个心肌梗塞区。对福尔马林固定的组织石蜡切片进行C4D、C9和肌钙蛋白T的免疫组织化学染色。结果：C4D和C9抗体在所有的心肌梗死标本中与坏死的心肌细胞反应强烈和弥漫，持续2天(19/19；100%)。相邻的组织学正常的心肌细胞无反应，导致受损和存活的心肌之间有清晰的分界。反应性随持续时间的延长而下降，在瘢痕中不存在。肌钙蛋白T在炎性前病变中显示缺失(8/13；62%)；然而，在阴性对照和存活心肌中存在非特异性斑块缺失。免疫组化在2例患者中提供了新的诊断，包括再梗塞和新诊断的急性心肌梗死。结论：C4D和C9对坏死心肌细胞具有类似的反应性和特异性。在炎症细胞流入之前，坏死性心肌细胞的C4D和C9染色明显，这表明在早期心肌梗死中有实用价值。在一些组织学正常的心肌组织中，肌钙蛋白T的片状丢失限制了其作为梗塞的唯一标志物的有效性。(ARCH Pathol Lab Med.2010；134：256-263)
Context.-Full activation and involvement of the complement pathway follows acute myocardial infarction. Complement fragment C4d is a stable, covalently bound marker of complement activation. Troponin T is specific for cardiomyocytes.Objectives.-To determine the specificity of C4d, C9, and troponin T immunoreactivity in necrotic myocytes and to establish whether they can be used to delineate acute myocardial infarction.Design.-Twenty-six autopsy cases with a total of 54 myocardium areas of infarction were reviewed retrospectively. Immunohistochemistry for C4d, C9, and troponin T was used on paraffin sections of formalin-fixed tissue. Controls consisted of 5 cases without evidence of infarction, and histologically normal myocardium functioned as an internal control.Results.-C4d and C9 antibodies reacted strongly and diffusely with necrotic myocytes in all samples of infarctions for up to 2 days ( 19 of 19; 100%). Adjacent histologically normal myocytes were nonreactive, resulting in a clear delineation between damaged and viable myocardium. Reactivity declined with increased duration and was absent in scars. Troponin T showed loss of staining in preinflammatory lesions ( 8 of 13; 62%); however, nonspecific patchy loss of staining was present in negative controls and in viable myocardium. Immunostains provided new diagnoses in 2 cases, including evidence of reinfarction and a newly diagnosed acute myocardial infarction.Conclusions.-C4d and C9 have comparable reactivity and specificity for necrotic myocytes. C4d and C9 staining of necrotic myocytes is apparent before the influx of inflammatory cells, demonstrating utility in early myocardial infarction. Patchy loss of Troponin T in some cases of histologically normal myocardium limited its usefulness as a sole marker of infarction. ( Arch Pathol Lab Med. 2010; 134:256-263)