The role of microvascular injury in the pathogenesis of cutaneous lesions of dermatomyositis
The role of microvascular injury in the pathogenesis of cutaneous lesions of dermatomyositis
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DOI：
10.1016/s0046-8177(96)90132-x
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发表时间：
1996-01-01
期刊：
影响因子：
3.3
通讯作者：
Magro, CM
中科院分区：
文献类型：
--
作者：
Crowson, AN;Magro, CM
虽然微血管损伤被认为是皮肌炎（DM）骨骼肌损伤的发病基础，但其在光镜下难以与系统性红斑狼疮（SLE）和亚急性红斑狼疮（SCLE）区分的皮肤病变发生中的作用尚未分析。作者的目的是评估微血管损伤在DM、SLE和SCLE皮肤病变发病机制中的作用。将20名肌病性DM患者和11名无肌病性DM患者的病变皮肤活检的光学显微镜特征与8名SLE患者的8份病变皮肤活检和12名SCLE患者的12份病变皮肤活检进行比较。采用免疫组织化学方法和因子VIII抗体测定三组的血管密度。用间接免疫荧光法检测C-5 b-9的沉积，用直接免疫荧光法检测其他免疫反应物的沉积。与红斑狼疮（LE）相比，DM的病变表现出更严重的内皮损伤、血管扩张和血管纤维蛋白沉积;在肌病性DM与无肌病性DM之间没有差异。DM中血管中的C（5 b-9）沉积显著大于LE中。与LE对照组相比，DM病变中的浅表血管丛密度降低，其中在肌病性DM中观察到最大的降低。肌源性糖尿病的上皮细胞损伤和粘蛋白最严重。微血管损伤是糖尿病皮肤病变的明显病理生理基础。对微血管病变的仔细观察有助于区分DM与SLE和SCLE。间接免疫荧光检测使用单克隆抗体C-5 b-9是一个有价值的工具，区分从LE病变皮肤活检DM。版权所有（C）1996，W.B，Saunders Company
Although microvascular injury has been postulated as the pathogenetic basis of skeletal muscle injury in dermatomyositis (DM), its role in the genesis of the skin lesions, which are said to be difficult to distinguish Light microscopically from systemic lupus erythematosus (SLE) and subacute lupus erythematosus (SCLE), has not been analyzed. The authors' intention was to assess the role of microvascular injury in the pathogenesis of skin lesions in DM, SLE, and SCLE. Light microscopic features of biopsies of lesional skin from 20 patients with myopathic DM and 11 with amyopathic DM were compared to eight lesional skin biopsies from eight patients with SLE and 12 lesional skin biopsies from 12 patients with SCLE. Vascular density was com pared in the three groups using an immunohistochemical preparation with an antibody to factor VIII. In 12 biopsies from the DM group, and in 19 of 20 lupus erythematosus (LE) specimens, frozen tissue was available, An indirect immunofluorescence methodology was used to detect C-5b-9 deposition, and direct immunofluorescence studies for other immunoreactants were performed in standard fashion, Compared with LE, lesions of DM showed a greater degree of endothelial injury, vascular ectasia, and vascular fibrin deposition; there were no differences between myopathic versus amyopathic DM.C(5b-9)deposition in vessels was significantly greater in DM than in LE, The superficial vascular plexus density was reduced in lesions of DM versus LE control groups with the greatest reduction observed in myopathic DM. Epithelial injury and mucin was greatest in myopathic DM. Microvascular injury is the apparent pathophysiological basis of skin lesions in DM. Careful attention to microvascular pathology enables distinction of DM from SLE and SCLE. Indirect immunofluorescence testing using a monoclonal antibody to C-5b-9 is a valuable tool to distinguish DM from LE in biopsies of lesional skin. Copyright (C) 1996 by W.B, Saunders Company