Immunological Research on Intractable Diseases of the Oral Mucosa

对口腔黏膜的各种疾病进行了临床和免疫学研究，以研究哪些因素与疾病的顽固性改变或恶性转化有关。复发性阿弗顿溃疡分为三种临床类型；小口疮（MiAU），大口疮（MjAU）和疱疹状溃疡（HU）。MiAU是最常见的，MjAU约占所有病例的25%，主要包括复发性口疮的难治性病例。MjAU在白塞氏病中更为常见。顽固性口腔扁平苔藓多见于糜烂型。免疫荧光研究对该病的鉴别诊断有重要意义。免疫过氧化物酶法显示，口腔扁平苔藓基底细胞层中OKT-6阳性朗格汉斯细胞较多，上皮下层中OKT-8阳性T淋巴细胞较多。在干燥病中，唾液腺闪烁放射照相在疾病的临床分期分析中非常有用。免疫学研究显示血清中存在一些自身抗体，包括抗核抗体、抗dna抗体、抗SS-A抗体和多克隆B细胞增生倾向。需要进一步的研究，包括基于HLA分型的疾病敏感性分析。口腔白斑的历史病例原细胞分析显示，198例患者260个病变中有11个病变在平均病程5年5个月后发生恶性转化。斑点型舌白斑伴或不伴组织学上皮发育不良均可视为恶性病变的相对高危人群。采用免疫荧光组织病理学方法对天疱疮和良性黏膜类天疱疮进行研究。直接免疫荧光法可用于鉴别诊断，间接检测血清抗体滴度法也可用于诊断患者的进一步临床病程。

Clinical and immunological researches have been performed on various diseases of the oral mucosa in order to study what kind of factors are concerned with intractable change or malignant transformation of the diseases.Recurrent aphthous ulcers were classified in three clinical types; minor aphthous ulcers (MiAU), major aphthous ulcers (MjAU), and herpetiform ulcers (HU). MiAU was most common, however, MjAU which consist of about 25% of all cases mostly included intractable cases of recurrent aphthous ulcers. MjAU was more frequent in Behcet's diseases. Intractable oral lichen planus was mostly found in erosive type. Immunofluorescent study was useful in differential diagnosis of the disease. Immunoperoxidase method revealed prominence of OKT-6 positive Langerhans cells in basal cell layer and OKT-8 positive T lymphocytes in subepithelial layer of oral lichen planus.In Sjogren's disease, salivary gland scintillation radiography was quite useful in clinical stage analysis of the disease. Immunological study exhibited some serum autoantibodies including antinuclear antibody, anti-DNA antibody, anti SS-A antibody, and tendency of polyclonal B cell hyperplasia. Further studies including the disease sensitivity analysis based on HLA typing would be requested.Histolical case protocall analysis on oral leukoplakia revealed that 11 lesions out of 260 lesions in 198 patients showed malignant transformation after average duration of 5 years 5 months. Speckled type leukoplakia of the tongue even with or without histological epithelial dysplasia can be considered as relatively high risk group to go malignant.Pemphigus and benign mucous membrane pemphigoid were studied by immunofluorescent histopathology. Direct immunofluorescent method was quite useful in differential diagnosis, and indirect method detecting serum antibody titers was also devoted in diagnosing further clinical courses of the patients.