溃疡性结肠炎和克罗恩病的临床病理特征及HLA-G在其鉴别诊断中的应用

Clinicopathological features of ulcerative colitis and Crohn's disease and value of HLA-G expression in their differential diagnosis

目的探讨溃疡性结肠炎(UC)和克罗恩病(CD)的临床病理特征及HLA-G在其鉴别诊断中的应用。方法对15例UC和49例病灶限于结肠及回盲部的CD进行临床病理和免疫组化染色的比较。结果①跳跃式分布、鹅卵石症、肠瘘或穿孔、透壁炎、裂隙状溃疡、肉芽肿、隐窝脓肿、杯状细胞减少、幽门腺化生及淋巴细胞聚集改变在UC和CD均有显著差异;②49例CD中28例(57.1%)肠黏膜腺上皮HLA-G(+),UC及正常对照组则(-)。结论①CD较具特征性的改变有跳跃式分布、鹅卵石症、肠瘘或穿孔、透壁炎、裂隙状溃疡、肉芽肿、幽门腺化生及淋巴细胞聚集,而隐窝脓肿和杯状细胞减少更多见于UC。②HLA-G在UC和CD的表达差异使其可以作为一个指标来帮助鉴别两者。

Objective To investigate the pathological features of ulcerative colitis （UC） and Crohn＇s disease （CD） and value of HLA-G expression in their differential diagnosis. Methods Fifteen cases of UC and 49 CD were enrolled in this study, which located in colon and ileocecal junction. A comparative analysis was carried out in the clinicopathological features and immunohistochemical staining between them. Results （1） Skip lesions, pseudopolyp, cobblestoning, strictures, fistula or perforation, inflammatory distribution, fissural ulcer, granulomas, crypt abscess, goblet cell depletion, pyloric gland metaplasia and lymphocyte aggregation have significant difference between UC and CD. （2） HLA-G protein localized in the intestinal glandular epithelium of 28 of 49 （57.1% ） CD patients, but totally absent in UC patients and normal control. Conclusion （ 1 ） CD exhibits distinctive clinicopathological features, such as skip lesions, cobblestoning, fistula or perforation, inflammatory distribution, fissural ulcer, granulomas, pyloric gland metaplasia and lymphocyte aggregation. Crypt abscess and goblet cell depletion are more frequently found in UC. （2） Different HLA-G expression may serve as a marker for distinguishing UC from CD.