Clinical implication of Dendritic Cell Infiltration in Cervical Tuberculous Lymphadenitis

결핵성 경부 림프절염에서 수지상돌기세포의 침윤과 임상양상의 연관성

  • Jung, Jae Woo (Department of Internal Medicine, College of Medicine, Chung-Ang University) ;
  • Lee, Young Woo (Department of Internal Medicine, College of Medicine, Chung-Ang University) ;
  • Choi, Jae Cheol (Department of Internal Medicine, College of Medicine, Chung-Ang University) ;
  • Yoo, Seung Min (Dept. of Radiology, College of Medicine, Chung-Ang University) ;
  • Lee, Hwa Yeon (Dept. of Radiology, College of Medicine, Chung-Ang University) ;
  • Lim, Seoung Young (Department of Internal Medicine, Kangbuk Samsung Hospital, Sung Kyun Kwan University, School of Medicine) ;
  • Shin, Jong Wook (Department of Internal Medicine, College of Medicine, Chung-Ang University) ;
  • Kim, Jae Yoel (Department of Internal Medicine, College of Medicine, Chung-Ang University) ;
  • Park, In Whn (Department of Internal Medicine, College of Medicine, Chung-Ang University) ;
  • Kim, Mi Kyung (Dept. of Pathology, College of Medicine, Chung-Ang University) ;
  • Choi, Byoung Whui (Department of Internal Medicine, College of Medicine, Chung-Ang University)
  • 정재우 (중앙대학교병원 내과학교실) ;
  • 이영우 (중앙대학교병원 내과학교실) ;
  • 최재철 (중앙대학교병원 내과학교실) ;
  • 유승민 (중앙대학교병원 진단영상의학과교실) ;
  • 이화연 (중앙대학교병원 진단영상의학과교실) ;
  • 임성용 (성균관대학교 강북삼성병원 내과학교실) ;
  • 신종욱 (중앙대학교병원 내과학교실) ;
  • 김재열 (중앙대학교병원 내과학교실) ;
  • 박인원 (중앙대학교병원 내과학교실) ;
  • 김미경 (중앙대학교병원 해부병리학교실) ;
  • 최병휘 (중앙대학교병원 내과학교실)
  • Received : 2006.02.14
  • Accepted : 2006.05.03
  • Published : 2006.05.30

Abstract

Background : Cervical tuberculous lymphadenopathy is a very common disease with a similar incidence to pulmonary tuberculosis. Dendritic cells play a role of initial antigen presentation of this illness. Nevertheless, the precise role of these antigen-presenting cells according to the clinical features in unclear. The aim of this study was to determine the clinical implication of dendritic cell infiltration in the cervical lymph nodes. Methods : A review of the clinical characteristics was carried out retrospectively based on the clinical records and radiography. Immunohistochemical staining was performed on the available histology specimens of 72 cases using the S-100b polyclonal antibody for dendritic cells. The number of dendritic cells with tuberculous granuloma were determined. A $X^2$ test, unpaired T test and multiple logistic regression analysis were performed. Results : Thirty percent of subjects had previous or concurrent pulmonary TB. Twenty one percent of cases showed a positive reaction on the AFB stain. Within a granuloma, the number of infiltrated dendritic cells was $113.0{\pm}7.0$. The incidence of fever and cough decreased with increasing infiltration of dendritic cells Multivariate regression analysis showed that the infiltration of dendritic cells could significantly contribute to fever. Conclusion : Overall, dendritic cells can control a Mycobacterium tuberculosis infection and modulate the immune response, as well as resolve the clinical manifestations of TB lymphadenopathy.

연구배경: 결핵성 경부 림프절염은 우리나라에서 폐결핵만큼 빈도가 높은 질환이다. 이 질병에서 수지상돌기세포는 초기의 항원 제시역할을 하고 있다. 그러나 림프절염의 임상 양상과 관련된 항원제시세포의 역할은 아직 명확하게 밝혀져 있지 않은 상태이다. 경부 림프절의 수지상 돌기세포의 침윤과 임상양상과의 연관성을 알아보기 위해 본 연구를 시행하였다. 방 법: 환자들의 입원기록 및 방사선사진을 바탕으로 후향적으로 고찰하였다. 72례의 조직표본을 대상으로 항산균도말염색을 다시 시행하였고, 수지상돌기세포의 단클론항체로 S-100b를 이용하여 면역조직 화학염색을 시행한 후, 각각 결핵성 육아종안의 수지상돌기세포의 수를 세어 비교분석하였다. 결 과: 결핵성 경부 림프절염이 있는 환자들의 30%가 폐결핵의 과거력이 있거나 현재 폐결핵을 앓고 있는 상태이었고 21%의 환자에서 항산균도말염색양성을 보였다. 이들 한 육아종안에 침윤된 수지상돌기세포의 수는 평균 $113.0{\pm}7.0$개이었다. 육아종내 수지상돌기세포의 침윤수가 증가됨에 따라 발열과 기침의 빈도는 감소하였고 항산균도말염색상에서 결핵균의 수가 더 감소하는 결과를 보였으며, 다중로짓회귀분석을 보면, 수지상돌기세포의 침윤은 특징적으로 발열에 기여하여하는 것으로 나타났다. 결 론: 수지상돌기세포가 결핵성 경부 림프절염에서 발열과 기침 등의 전신증상을 줄이고, 결핵균의 침윤정도를 감소시키는 것으로 확인되었고, 이는 수지상돌기세포가 Mycobacterium tuberculosis의 감염을 조절하고 이와 함께 면역반응도 조절하여, 결핵성 경부 림프절염에서의 임상양상을 결정하는 것으로 생각된다.

Keywords

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