Immunopathology Investigation Of Vascular Wall Of Patients With Thromboangiitis Obliterans

Objective:To summarize the pathological transform of vascular wall of patients with thromboangiitis obliterans(TAO) by pathological observation and to approach the relationship between immunologic injury of vascular wall and TAO by immunopathology investigation of vascular wall of patients with TAO.In order to approach the new therapy to TAO and to provid theory support and preliminary feasibility analysis to the new therapy.Methods:The vascellums of affected limbs of twenty-nine patients with TAO treated in our hospital from 2005 to 2007 were case group. The vascellums of affected limbs of thirty-two patients with other diseases treated in our hospital from 2005 to 2007 were control group .Pathological sections were made, all sections were stained by Hematoxylin and Eosin, then were observed by microscope. And CD3 and CD20 cells were detected in surgical specimens from twenty-nine cases of TAO and thirty-two cases of other diseases by immunohistochemical staining with streptavidin-horseradish peroxidase detective system. Results:1. The vascular walls of all cases of TAO group were much more thicker than that of control group, endomembrane accrementition was extremely evident, accompanied the infiltration of lympholeukocyte. Elastic intima was partialy fractured and destroyed in twenty-five cases of TAO group. Fibrous degeneration and complicated alinement of smooth muscle were evident in tunica media of vascular wall in twelve cases of TAO group. Tunica adventitia accrementition was seen in two cases of TAO group. Infiltration of the inflammatory corpuscle in both tunica media and tunica adventitia were not evident in all cases of TAO group. Intimal impairment was predominant in vascular impairment of TAO, the contrast was singificant(P<0.05). Infiltration of lympholeukocyte was extremely evident at endomembrane, the contrast was singificant(P<0.05). Vascular impairment and infiltration of lympholeukocyte was not seen in all cases of control group, the contrast was singificant(P<0.01).2. The number of CD3 and CD20 positive cells of TAO group were much higher than that of control group(P<0.01).In TAO group, the number of CD3 positive cells were higher than the number of CD20 positive cells(P<0.05). The distribution of CD3 positive cells and CD20 positive cells were differential. The distribution of seventy percent of CD3 positive cells were much near the endodermis, the distribution of ninty-seven percent of CD20 positive cells were much near the elastic intima , the contrast was singificant(P<0.01).Conclusion:1. Inflammatory reaction and the disorganizations caused by the inflammatory reactions were extremely evident in the vascular walls of patients of TAO, intimal impairment was more predominant. The impairments of vascular wall were idiopathetic immunologic injury. Most of infiltrative cells were lympholeukocyte, infiltration of lympholeukocytes were extremely evident at endomembrane. Idiopathetic immunologic injury at endomembrane was pathological foundation of the morbility of TAO and the primary pathological transform of vascular wall of the patients with TAO.2. The relationship between immunologic injury and the morbility of TAO was intimate. Both the direct corpuscular immunologic injury caused by CD3 positive T-lympholeukocyte and the more severe humoral immunologic injury caused by the degrade of inhibitive function to humoral immunity of the CD3 positive T-lympholeukocyte played very significance role in immunologic injurys of the vascular walls. So the CD3 positive T-lympholeukocyte played a more ntimate and significance role in the morbility of the TAO.3. TAO was idiopathetic immunologic disease which caused by the accentuation of humoral immunity and the degression of cell immunity. Function abnormality of T-lympholeukocyte may play a significant role. T-lympholeukocyte function accommodation and stem cell transplantation may be considerable treat for TAO.