嗜酸性粒细胞在溃疡性结肠炎患者中的临床及病理学意义

Clinicopathological significance of eosinophil granulocyte infiltration in the intestinal mucosa of patients with ulcerative colitis

目的:探讨嗜酸性粒细胞(EG)与评判溃疡性结肠炎(UC)病情的其他指标的一致性,病理组织学特征与EG的关系.方法:选取2007-11/2008-12就诊于湘雅二医院并诊断为UC患者45例,将患者分为:活动组(n=45)与好转组(n=39,在治疗6wk到最后1d,经DAI、EAI及组织病理学评分,完全缓解和部分缓解的患者).采用CAI积分、EAI积分及组织病理学积分评价疾病活动度,并进行EG计数.结果:UC患者结肠黏膜组织中的炎症细胞浸润以中性粒细胞、淋巴细胞、浆细胞以及EG为主,活动组较好转组为重.固有层小血管病变和腺体病变以及隐窝脓肿的出现均以活动组为重.间质改变好转组较多.EG计数与中性粒细胞计数在好转组呈负相关(r=0.568,P=0.001).EG浸润的出现在活动组与淋巴组织增生、淋巴滤泡形成呈正相关(r=0.755,0.524,均P<0.01),与灶性出血呈负相关(r=-0.385,P=0.010).而好转组患者中,仅有杯状细胞消失与EG浸润呈正相关(r=0.349,P=0.046).结论:EG可能为判断UC活动或好转的指标.

AIM： To examine eosinophil granulocyte （EG） infiltration in the intestinal mucosa of patients with ulcerative colitis （UC） and analyze the correlation of EG infiltration with clinical activity index （CAI）, endoscope activity index （EAI） and histopathological parameters of the disease. METHODS： Forty-five UC patients treated at our hospital from November 2007 to December 2008 were divided into two groups according to disease activity： active group （n = 45） and remission group （n = 39, patients achieving complete and partial remission after treatment for 6 weeks or more during entire treatment course）. CAI, EAI and histopathological parameters were used to evaluate disease activity. The number of EGs was counted. RESULTS： The intestinal mucosa of UC patientswas infiltrated mainly by neutrophils, lymphocytes, plasmatocytes and EGs. The inflammatory infiltration was more severe in the active group than in the remission group. Pathological changes in small vessels and glands in the lamina propria as well as crypt abscess were more severe in the active group than in the remission group, while mesenchymal change was more significant in the remission group than in the active group. A significant negative correlation was found between the number of EGs and neutrophils in remitted patients （r = 0.568, P = 0.001）. In the active group, EG infiltration was positively correlated with lymphadenosis and formation of folliculi lymphaticus （r = 0.755 and 0.524, respectively; both P〈0.01）, and negatively with focal hemorrhage （r = -0.385, P = 0.010）. In the remission group, EG infiltration was positively correlated with goblet cell disappearance （r = 0.349, P = 0.046）. CONCLUSION： EG infiltration is a potential parameter for evaluating UC activity.