活检病理对诊断溃疡性结肠炎的价值

Evaluation of biopsy pathology in diagnosis of ulcerative colitis

目的分析溃疡性结肠炎(UC)患者的病理组织学特征,并评价活检对诊断UC的作用和限度.方法用“英国IBD活检指南上标准”对69例活动期UC和13例缓解期UC的病理切片进行盲法观察,并在此基础上套用“Theodossi评分系统”对UC进行病理诊断分析。结果活动性UC组织病理学特征阳性率超过50％的有粘膜表面改变(63.8％)、隐窝结构紊乱(78.3％)、隐窝减少(69.6％)、全层粘膜明显炎症(89.9％)、中性粒细胞浸润(97.1％)、嗜酸性粒细胞浸润(81.2％)、基底浆细胞增生(53.6％)、隐窝炎(68.1％)、上皮变化(88.4％)、杯状细胞减少(72.5％),上皮间中性粒细胞浸润(65.2％),除粘膜表面改变以外,其他这些病理组织学特征活动期与缓解期UC比较均有显著性差异(P<0.05).54例活动性UC(78.3％)病理上能作出UC诊断,而缓解期UC无一例可以诊断。结论活动性UC主要病理组织学特征是粘膜重度慢性炎症,粘膜表面和上皮发生改变,隐窝结构紊乱,隐窝减少,基底浆细胞增生,隐窝炎,隐窝脓肿,杯状细胞减少,上皮间中性粒细胞浸润;Theodossi评分系统对诊断UC有一定价值。

AIM To analyze the histopathological features of the ulcerative colitis(UC) and to assess the role and limitation of biopsy in the diagnosis of UC. METHODS Pathological sections stained with HE from 69 cases of active UC and 13 cases of quiescence UC were observed blindly under microscopy. The criteria of histopathological features were mainly based on the criteria for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease initiated by the British Society of Gastroenterology. The pathological diagnosis of UC was made with 'Theodossi score system'. RESULTS The positive rate of histopathological features over 50% in active UC were mucosal surface changes (63. 8%), crypt architectural abnormalities (78.3%), the crypt number decrease (69.6%), diffuse inflammation (89.9%), neutrophil infiltration (97.1%), eosinophils infiltration (81.2%), basal plasmacytosis (53. 5%), cryptitis (68.1%), epithelial changes (88.4%), mucin depletion (72.5%) and intraepithelial neutrophil infiltration (65.2%). There were significant differences in the histopathological features in addition to mucosal surface changes between active UC and quiescence UC (P <O.05). Fiftey-four active UC patients (78.3%) were diagnosed pathologically, whereas no quiescence UC patients were diagnosed. CONCLUSIONS The main histopathological features of UC were severe diffuse inflammation, mucosal surface and epithelial changes, crypt architectural abnormalities, crypt number decrease, basal plasmacytosis, cryptitis, crypt abscess, mucin depletion and intraepithelial neutrophil infiltration. The 'Theodossi score system' plays a role in the diagnosing UC.