Аннотация
Введение. Врожденный гиперинсулинизм (ВГ), проявляющийся в диффузной (ДВГ), очаговой (ОВГ) и атипичной формах, представляет трудности для морфологической диагностики. Целью исследования был морфологический анализ факторов транскрипции NeuroD1, Nkx2.2, Isl1; соматостатина и хромогранина А при ДВГ и ОВГ. Материал и методы. Имуногистохимическое исследование с антителами к хромогранину А, инсулину, соматостатину, NeuroD1, Nkx2.2, Isl1, морфометрический анализ фрагментов резецированной поджелудочной железы (ПЖ) 18 детей с ВГ до 4 лет и неизмененной ПЖ 9 детей до 1 года. Результаты. Соматостатин в группе ДВГ экспрессировался в 26,3±3,3% клеток островков Лангерганса и 2,1±0,4% клеток экзокринной части. При ОВГ он экспрессировался в 41,1±6,8% клеток эндокринной части, в 14,2±2,6% клеток аденоматозных зон и в 2,3±0,6% клеток экзокринной части. При ДВГ Isl1 экспрессировался в 59,8±7,1% клеток островков Лангерганса и в 4,0±0,7% клеток экзокринной части. При ОВГ Isl1 экспрессировали в островках Лангерганса 87,3±3,2% клеток, в аденоматозных структурах – 88,3±1,5%, в экзокринной части – 6,5±1,7%. Nkx2.2 при ДВГ и ОВГ в островках Лангерганса экспрессировали соответственно 55,9±7,9 и 69,3±10,4% клеток, а в экзокринной части – 5,3±1,7% и 5,4±1,3%. В аденоматозных структурах уровень его экспрессии был сопоставим с Isl1. NeuroD1 при ДВГ и ОВГ в островках Лангерганса экспрессировали соответственно 58,4±9,7 и 83±4,7% клеток, в экзокринной части – 65,5±7,4 и 77,3±9,4%, в аденоматозных структурах – 80,2±10,9%. Количество клеток с экспрессией хромогранина А, Isl1, Nkx2.2 и NeuroD1 в эндокринной части, а NeuroD1 – и в экзокринной части при ДВГ и ОВГ было достоверно выше, чем в неизмененной ПЖ. Заключение. Наиболее демонстративным иммуногистохимическим маркером ВГ является NeuroD1, в то время как экспрессия соматостатина достоверно не повышается.
Авторы и аффилиации
Л.Б. Митрофанова, доктор медицинских наук, А.О. Хазратов, Б.Э. Гальковский, А.А. Сухоцкая, кандидат медицинских наук, В.Г. Баиров, доктор медицинских наук, профессор, Д.В. Рыжкова, доктор медицинских наук, М.Д. Пойда, И.Л. Никитина, доктор медицинских наук ФГБУ «НМИЦ им. В.А. Алмазова», Российская Федерация, 197143, Санкт-Петербург, ул. Аккуратова, д. 2 E-mail: lubamitr@yandex.ru
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