A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome
A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome
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DOI：
10.2106/00004623-200407000-00014
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发表时间：
2004-07-01
影响因子：
5.3
通讯作者：
An, KN
中科院分区：
文献类型：
--
作者：
Ettema, AM;Amadio, PC;An, KN
背景：腕管综合征最常见的组织学发现是非炎症性滑膜纤维化。轻微损伤的累积效应被认为是某些腕管综合征病例的重要病因。我们寻求证据，这种损伤的滑膜组织的患者腕管综合征和尸体controls.Methods：我们比较了滑膜标本从30例特发性腕管综合征与标本从对照组的10个新鲜冷冻尸体的个人谁没有生前诊断腕管综合征，谁符合相同的排除标准。分析包括组织学和免疫组化检查的胶原蛋白I，II，III和VI型和转化生长因子-β（TGF-β）RI，RII和RIII的分布。结果：组织学检查显示，从患者标本与对照标本相比，成纤维细胞密度，胶原纤维大小和血管增生显着增加（p < 0.001）。在患者或对照组的滑膜中均未发现I型和II型胶原，但VI型胶原是两者的主要成分。患者的III型胶原纤维比对照组更丰富（p < 0.001）。TGF-β RI在患者和对照组织中的上皮细胞和成纤维细胞中均有表达，与对照组织相比，患者成纤维细胞中的表达显著增加（p < 0.001）。这些发现与皮肤、肌腱、提示特发性腕管综合征患者可能持续滑膜下结缔组织损伤。临床相关性：滑膜下结缔组织的变化不仅可能导致腕管内容物体积增加，还可能改变其材料特性，如顺应性和对液体流动的渗透性以及血管分布。这些变化反过来可能会使滑液下结缔组织容易受到额外的损伤，并导致腕管综合征患者腕管压力升高。
Background: The most common histological finding in carpal tunnel syndrome is noninflammatory synovial fibrosis. The accumulated effect of minor injuries is believed to be an important etiologic factor in some cases of carpal tunnel syndrome. We sought evidence of such injuries in the synovial tissue of patients with carpal tunnel syndrome and in cadaver controls.Methods: We compared synovial specimens from thirty patients who had idiopathic carpal tunnel syndrome with specimens from a control group of ten fresh-frozen cadavers of individuals who had not had an antemortem diagnosis of carpal tunnel syndrome and who met the same exclusion criteria. Analysis included histological and immunohistochemical examination for the distribution of collagen types I, II, III, and VI and transforming growth factor-beta (TGF-beta) RI, RII, and RIII.Results: Histological examination showed a marked increase in fibroblast density, collagen fiber size, and vascular proliferation in the specimens from the patients compared with the control specimens (p < 0.001). Collagen types I and II were not found in the synovium of either the patients or the controls, but collagen type VI was a major component of both. Collagen type-III fibers were more abundant in the patients than in the controls (p < 0.001). Expression of TGF-beta RI was found in the enclothelial cells and fibroblasts in the patient and control specimens, with a marked increase in expression in the fibroblasts of the patients compared with that in the control tissue (p < 0.001).Conclusions: These findings are similar to those after injury to skin, tendon, and ligament and suggest that patients with idiopathic carpal tunnel syndrome may have sustained an injury to the subsynovial connective tissue.Clinical Relevance: The changes demonstrated in the subsynovial connective tissue not only could lead to an increase in the volume of the contents in the carpal tunnel but also may alter its material properties, such as compliance and permeability to fluid flows, and vascularity. These changes may, in turn, predispose the subsynovial connective tissue to additional injury and contribute to the elevation in carpal tunnel pressure seen in patients with carpal tunnel syndrome.