目的:通过免疫组化分析,评估M1和M2巨噬细胞极化在根尖周囊肿和根尖肉芽肿中的作用,以及巨噬细胞极化与组织病理学诊断之间的相关性。锥形束计算机断层扫描的临床特征和病变体积。
方法:通过免疫组织化学方法分析诊断为根尖囊肿(n=52)和根尖肉芽肿(n=51)的根尖周活检。包括没有根管治疗史的根尖周病变(原发性病变)和根管治疗持续病变(持续病变)的牙齿。病理诊断,患者年龄,性别和临床特征来自治疗记录.根据病变的体积,将锥形束计算机断层摄影根尖周体积指数(CBCTPAVI)评分分配给每个根尖周病变。定量CD68和CD163的免疫表达。采用CD68/CD163比值表示M1或M2巨噬细胞极化。Mann-WhitneyU检验用于确定神经根囊肿和根尖周围肉芽肿组之间的CD68/CD163比率。采用Spearman相关性检验评估CD68/CD163比值与病灶体积及CBCTPAVI评分的相关性。
结果:根性囊肿和根尖周围肉芽肿的CD68/CD163中位数为2.05(IQR=1.33)和1.26(IQR=0.81),分别。在根性囊肿中观察到明显更高的CD68/CD163比率(p<.001)。相比之下,根尖周围肉芽肿的CD68/CD163比值中位数显著较低.较大的病变有较高的CD68/CD163比值中位数,而较小的病变的CD68/CD163比值中位数较低(p=.007,rs=.262)。CD68/CD163比值与整个根尖周病变的CBCTPAVI评分显著相关(p=.002,rs=.306)。与较小的病变相比,较大病变中的较高CD68/CD163比率表明更高的M1极化程度。关于病理诊断,在根尖周围肉芽肿中CBCTPAVI评分与CD68/CD163比值呈显著正相关(p<.001,rs=.453),而根性囊肿呈负相关(p<.001,rs=-.471)。
结论:根尖周围肉芽肿的特征是M2显性巨噬细胞极化,而根性囊肿具有显著较高的M1巨噬细胞。M1巨噬细胞极化程度越高,总体根尖周病变和根尖周肉芽肿的体积越大,CBCTPAVI评分越高。
OBJECTIVE: To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone-beam computed tomography.
METHODS: Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients\' age, gender and clinical characteristics were obtained from treatment records. A cone-beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno-expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann-Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman\'s correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score.
RESULTS: Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p < .001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p = .007, rs = .262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p = .002, rs = .306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p < .001, rs = .453), whereas the negative correlation was observed for radicular cysts (p < .001, rs = -.471).
CONCLUSIONS: Periapical granulomas are characterized by a M2-dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma.