Histopathological study on developmental mechanism of the coronary, artery destruction in acute stage Kawasaki Disease patients

急性川崎患者冠状动脉病变中有中性粒细胞浸润，但临床资料显示外周血中有中性粒细胞活化，但尚无形态学证据。因此，我们对中性粒细胞在川崎病急性期冠状动脉损害中的作用进行了组织学研究。材料包括8例尸检的KD急性期死亡的患者。将组织固定并包埋在石蜡中。常规组织学检查采用苏木精-伊红染色、弹性货车Gieson染色和azan-Mallory染色。此外，CD 3、CD 20、CD 68、中性粒细胞弹性蛋白酶和免疫球蛋白的抗体用于免疫组织化学以鉴定动脉病变中的浸润细胞。所有患者冠状动脉病变中出现的炎性细胞均以巨噬细胞为主。此外，在KD发病后10天死亡的患者的冠状动脉病变中也发现了大量中性粒细胞。中性粒细胞浸润的高峰早于CD 68+巨噬细胞、CD 3+淋巴细胞和CD 20+淋巴细胞的高峰。提示中性粒细胞参与了川崎病早期冠状动脉的损害。中性粒细胞和巨噬细胞对血管壁的损伤可能导致血管扩张。我们比较了IVGG给药患者和未使用IVGG患者的冠状动脉病变组织学。结果表明，CD 20 ~+淋巴细胞浸润程度在后一种患者中有增高的趋势。而浆细胞、CD 68+细胞和中性粒细胞在两组间无差异。

There has been no morphological evidence that neutrophils infiltrate the coronary arterialn lesions of acute Kawasaki Disease(KD) patients, although clinical data indicate the activation of neutrophils in the peripheral blood. Therefore, we carried out histological examination about the role of neutrophils in the damage to coronary arteries in acute stage of KD. The materials consisted of eight autopsy patients who died during the acute phase of KD. The tissues were fixed and embedded in paraffin. Hematoxylin and eosin, elastica van Gieson and azan-Mallory stainings were performed for routine histological examination. In addition, antibodies to CD3, CD20, CD68, neutrophil elastase and immunoglobulins were used for immunohistochemistry to identify infiltrating cells in the arterial lesions. The inflammatory cells which appeared in the coronary arterial lesions were mainly composed of macrophages in all patients. In addition, numerous neutrophils were also identified in the coronary arterial lesions of the patients who died 10 days after the onset of KD. Neutrophilic infiltration reached a peak earlier than the peaks of CD68+ macrophages, CD3+ lymphocytes and CD20+ lymphocytes. These results suggest that neutrophils are involved in the damage occurring to coronary arteries in the early stage of KD. Vascular dilatation might occur as a result of damage to vascular walls caused by neutrophils, as well as macrophages. We compared histology of coronary arterial lesions between a patient with IVGG administration and a patient without IVGG. It showed the tendency that the degree of CD20+ lymphocytic infiltration was higher in the latter patient. However, there was not difference in plasma cells, CD68+ cells and neutrophils between two patients.