Grading of chronic synovitis -: A histopathological grading system for molecular and diagnostic pathology
Grading of chronic synovitis -: A histopathological grading system for molecular and diagnostic pathology
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DOI：
10.1078/0344-0338-5710261
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发表时间：
2002-01-01
影响因子：
2.8
通讯作者：
König, A
中科院分区：
文献类型：
--
作者：
Krenn, V;Morawietz, L;König, A
以下是一个用于测量滑膜组织炎症的简单组织病理学分类系统的方案。这个滑膜炎评分用于常规染色的常规切片，适用于各种滑膜炎，不论病因如何，包括以下相关的形态学改变。第一：滑膜衬里细胞层的增生/肥大。第二：固有细胞/滑膜间质的活化。第三：炎症浸润。所有明确的组织病理学特征从无（0）、轻度（1）、中度（2）到重度（3）进行分级，总分从0到9。0到1对应无滑膜炎（炎症等级 = 0）；2到3为轻度滑膜炎（炎症等级1）；4到6为中度滑膜炎（炎症等级2）；7到9为重度滑膜炎（炎症等级3）。
利用这个评分，我们分析了308例来自退行性（骨关节炎（OA））和炎性关节疾病——反应性关节炎（ReA）、银屑病关节炎（PA）和类风湿关节炎（RA）——的滑膜组织随机标本，以及来自健康个体的滑膜组织。结果发现，RA滑膜炎的平均等级显著高于OA的平均等级（p < 0.0005）以及健康对照组的平均等级（p < 0.0005）。相反，RA患者与PA和ReA患者的滑膜炎评分平均等级之间未发现显著差异。
根据施蒂尔分类对RA - 滑膜炎I型和II型进行的另一项比较显示，I型（p < 0.0005）的炎症浸润值显著更高，II型（p = 0.037）的间质活化值显著更高。
由于在OA中，滑膜炎被视为退行性软骨破坏的结果，而在炎性关节疾病（RA、PA、ReA）中，滑膜炎被认为是软骨破坏的原因，因此可以得出结论，分值较高表明滑膜炎的致病潜力，同时炎症评分可能有助于评估滑膜炎的破坏潜力。
此外，评分数据与施蒂尔RA - 滑膜炎类型的比较表明，该评分使我们能够区分滑膜炎类型的形态学特征。在实验病理学中，它可以提供关于滑膜组织分子分析的标准化信息，其中分子与形态学数据的相关性至关重要。在诊断病理学中，这个滑膜炎评分（与其他分类系统结合）可以提供关于滑膜组织炎症改变程度的基本和标准化信息。
The following is a proposition for a simple histopathological classification system to measure inflammation in synovial tissue. This synovitis-score is employed in conventionally stained routine sections, and is applicable to every kind of synovitis, irrespective of etiology and including the following relevant morphological alterations.First: hyperplasia/enlargement of synovial lining cell layer. Second: activation of resident cells/synovial stroma. Third: inflammatory infiltration.All defined histopathological qualities are graded from absent (0), slight (1) and moderate (2) to strong (3), with summaries ranging from 0 to 9. 0 to 1 corresponds to no synovitis (inflammatory grade = 0). 2 to 3 to a slight synovitis (inflammatory grade 1), 4 to 6 to a moderate synovitis (inflammatory grade 2), and 7 to 9 to a strong synovitis (inflammatory grade 3).Using this score, we analyzed 308 random specimens of synovial tissue from degenerative (osteoarthritis (OA)) and inflammatory joint diseases - reactive arthritis (ReA). psoriasis arthritis (PA) and rheumatoid arthritis (RA) - as well as synovial tissue from healthy individuals.The mean grade given to synovitis of RA turned out to be significantly higher than the mean grade of OA (p < 0.0005) and of healthy controls (p < 0.0005). On the contrary, no significant differences could be found between the mean grades of synovitis scores from patients with RA and those with PA and ReA.Another comparison between RA-synovitis types I and II according to the Stiehl classification resulted in type I (p < 0.0005), showing significantly higher values of inflammatory infiltration, and type II (p = 0.037), showing significantly higher values of stroma activation.Since in OA, synovitis is regarded as a result of degenerative cartilage destruction whereas in inflammatory joint diseases (RA, PA, ReA), synovitis is regarded to be the cause of cartilage destruction, it can be concluded that scores with considerable high values indicate the pathogenetic potential of synovitis and that the inflammatory score may be helpful in estimating the destructive potential of synovitis at the same time.Furthermore, the comparison of the score data with the Stiehl RA-synovitis types shows that the score enables us to discriminate the morphological peculiarities of the synovitis types. In experimental pathology, it could provide standardized information on molecular synovial tissue analyses where a correlation of molecular with morphological data is essential. In diagnostic pathology, this synovitis score (in combination with other typing systems) could provide basic and standardized information concerning the degree of inflammatory alterations in synovial tissue.