摘要目的 探讨黏蛋白抗体在真菌性鼻窦炎活检组织中的曲霉菌和毛霉菌鉴别中的意义.方法 选取北京同仁医院病理科2001-2006年间66例真菌性鼻窦炎活检标本存档蜡块,其中真菌球29例,变应性真菌性鼻窦炎12例,慢性侵袭性真菌性鼻窦炎24例,急性侵袭性真菌性鼻窦炎1例;确认曲霉菌属44例(烟曲霉菌31例,黄曲霉菌7例,土曲霉菌6例),毛霉科真菌22例(毛霉菌14例,根霉菌8例).用黏蛋白(MUC)2、MUC5AC和MUC5B抗体以免疫组织化学方法标记真菌,并与过碘酸-雪夫(PAS)和Grocott环六亚甲基四胺银(GMS)特殊染色结果进行对比.结果 MUC5B免疫组织化学结果显示烟曲霉菌、黄曲霉菌和土曲霉菌总阳性率为90.9%,毛霉菌和根霉菌总阳性率为4.5%,二者差异有统计学意义(P＜0.001);MUC2和MUC5AC均为阴性;PAS和GMS染色上述真菌均为阳性.结论 MUC5B抗体可作为检测组织内真菌的有效指标,应用MUC5B抗体可以对真菌性鼻窦炎中曲霉菌属和毛霉科真菌进行鉴别.

abstractsObjective To differentiate between Aspergillus species and Mucorales of fungal sinusitis by immunohistochemistry.Methods Formalin-fixed paraffin-embedded tissue blocks of 66 cases of fungal sinusitis were retrieved from the archival files of Department of Pathology of Beijing Tongren Hospital during the period from 2001 to 2006.The samples included 29 cases of fungal balls.12 cases of allergic fungal sinusitis,24 cases of chronic invasive fungal sinusitis and 1 case of acute invasive fungal sinusitis.The types of fungi were 44 Aspergillus species(31 cases of A.fumigatus,7 cases of A.flaw and 6 cases of A.terreus)and 22 Mucorales(14 cases of Mucor species and 8 cases of Rhizopus species).Immunohistochemistry was performed with MUC2,MUC5AC and MUC5B antibodies.The results were compared with histochemical study for periodic acid-Schiff(PAS)and Grocott methenamine silver(GMS)stains.Results Immunohistochemical study for MUC5B showed that the positive rate of Aspergillus species was 90.9%,in contrast to 4.5%in Mucorales(P＜0.001).The expression of MUC2 and MUC5AC was completely negative,whereas PAS and GMS stains were positive in all cases.Conclusion MUC5B antibody appears to be a useful immunohistochemical marker for identifying fungal types in tissue sections,especially in distinguishing between Aspergillus species and Mucorales in fungal sinusitis.