Increased angiogenesis and cellular proliferation as hallmarks of the synovium in chronic septic arthritis
Increased angiogenesis and cellular proliferation as hallmarks of the synovium in chronic septic arthritis
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DOI：
10.1002/art.23915
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发表时间：
2008-08-15
期刊：
影响因子：
--
通讯作者：
Schumacher, H. R.
中科院分区：
文献类型：
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作者：
Pessler, F.;Dai, L.;Schumacher, H. R.
客观的。表征慢性化脓性关节炎 (SeA) 患者滑膜的组织学改变和炎症浸润。方法。将 SeA 患者的滑膜（9 个标本；疾病持续时间 >4 周）与脓毒性关节假体松动患者的滑膜（脓毒症全关节置换术 [SeTA]；9 个标本）、类风湿性关节炎（RA；25 个标本）、骨关节炎（25 个标本）和正常组织学（10 个标本）患者的滑膜进行比较。切片用苏木精和伊红、组织革兰氏染色以及冯维勒布兰德因子（vWF；血管）、Ki-67（分裂细胞）、CD15（中性粒细胞）、CD3（T 细胞）、CD20（B 细胞）、CD38（浆细胞）和 CD68（巨噬细胞）免疫染色。结果。所有 SeA 和 SeTA 标本的革兰氏染色均为阳性。 SeA 和 SeTA 中以混合多形核和单核浸润为主。 SeA 可以通过较高密度的 CD15+ 细胞（SeA:RA 比率 6.5:1：P < 0.001）或 Ki-67+ 细胞（比率 2.1:1；P = 0.012）与 RA 区分开来。 SeTA 的炎症浸润与 SeA 相似，但含有较少的 CD3+ 细胞（SeTA 与 SeA 0.26:1；P = 0.009），并且 CD20+ 细胞有较少的趋势。 SeA 中的平均血管密度显着增加（SeA：正常比率 3.0:1；P < 0.001），SeTA 标本的血管化区域的平均血管密度也有较小程度的增加（SeTA：正常比率 1.9:1）。 Ki-67/CD31 双免疫染色显示小内膜下血管中内皮细胞增殖，表明血管生成。受试者工作特征曲线分析确定了较高密度的 CD15+ 和 Ki-67+ 细胞以及 vWF 阳性血管作为区分 SeA 和 RA 的组织学标志物。结论。对慢性化脓性关节炎患者滑膜的首次分析发现，作为组织病理学标志，存在显着的新血管形成和细胞增殖，并伴有持续的细菌定植和富含 CD15+ 中性粒细胞的异质炎症浸润。
Objective. To characterize histologic alterations and inflammatory infiltrates in the synovium of patients with chronic septic arthritis (SeA).Methods. Synovial membranes from patients with SeA (9 specimens; disease duration >4 weeks) were compared with specimens born patients with septic joint prosthesis loosening (septic total arthroplasty [SeTA]; 9 specimens), rheumatoid arthritis (RA; 25 specimens), osteoarthritis (25 specimens), and normal histology (10 specimens). Sections were stained with hematoxylin and eosin, tissue gram stain, and immunostains for von Willebrand factor (vWF; blood vessels), Ki-67 (dividing cells), CD15 (neutrophils), CD3 (T cells), CD20 (B cells), CD38 (plasma cells), and CD68 (macrophages).Results. Gram stains were positive in all SeA and SeTA specimens. Mixed polymorphonuclear and mononuclear infiltrates predominated in SeA and SeTA. SeA could be differentiated from RA by higher densities of CD15+ cells (SeA:RA ratio 6.5:1: P < 0.001) or Ki-67+ cells (ratio 2.1:1; P = 0.012). The inflammatory infiltrate of SeTA was similar to SeA but contained fewer CD3+ cells (SeTA versus SeA 0.26:1; P = 0.009) and a tendency toward fewer CD20+ cells. Mean vascular density was strikingly increased in SeA (SeA:normal ratio 3.0:1; P < 0.001) and, to a lesser extent, in the vascularized areas of the SeTA specimens (SeTA:normal ratio 1.9:1). Ki-67/CD31 double immunostains demonstrated proliferating endothelial cells in small subintimal blood vessels, suggesting angiogenesis. Receiver operating characteristic curve analysis identified higher densities of CD15+ and Ki-67+ cells and vWF-positive vessels as histologic markers that differentiated SeA from RA.Conclusion. This first analysis of the synovium in patients with chronic pyogenic arthritis identified dramatic neovascularization and cell proliferation, accompanied by persistent bacterial colonization and heterogeneous inflammatory infiltrates rich in CD15+ neutrophils, as histopathologic hallmarks.