成人乳糜泻多部位小肠活检的病理特征分析

Pathological Characteristics of Multiple Site Small Intestinal Biopsies in Adults With Celiac Disease

背景:乳糜泻是一种自身免疫性肠病,可表现为斑片状黏膜损伤。因此,其诊断应行多部位小肠活检进行组织学评估。目的:分析成人乳糜泻患者多部位小肠活检的病理特征,为乳糜泻的早期识别和诊断提供参考依据。方法:回顾性收集2019年8月—2022年4月在新疆维吾尔自治区人民医院首诊为乳糜泻的22例成人患者的病理资料。入组患者血清抗组织型转谷氨酰胺酶抗体IgA阳性,并于内镜下在十二指肠球部、降部和回肠末段取活检,由经验丰富的病理学家行改良Marsh分级。结果:十二指肠球部(50.0%)、降部(45.5%)最常见的病理分级均为MarshⅢc级,回肠末段为MarshⅢa级(63.6%)。分别有100%、95.5%和72.7%的十二指肠球部、降部和回肠末段活检显示乳糜泻特征性组织学改变。7例患者黏膜受累呈斑片状,其中1例病变见于十二指肠球部和回肠末段,6例病变局限于十二指肠。15例患者为十二指肠球部、降部和回肠末段弥漫性受累,其中4例3个活检部位Marsh分级一致,11例分级不一致。18例(81.8%)患者十二指肠是唯一受累部位或十二指肠病变较回肠末段更严重。结论:成人乳糜泻可能影响整个小肠,黏膜受累可呈斑片状,多部位多次活检可提高诊断率。

Background:Celiac disease is an autoimmune enteropathy which can present with patchy mucosal lesions.Therefore,the diagnosis of the disease requires histological evaluation of multiple site biopsies.Aims:To analyze the pathological characteristics of multiple site small intestinal biopsies in adult patients with celiac disease and provide reference for early identification and diagnosis of celiac disease.Methods:The pathological data of 22 adult patients who were newly diagnosed as having celiac disease at the People′s Hospital of Xinjiang Uygur Autonomous Region from August 2019 to April 2022 were collected retrospectively.All patients were positive for serum anti‑tissue transglutaminase antibody IgA,and biopsies of duodenal bulb,descending part of the duodenum and terminal ileum were obtained under endoscopy.Histological examination was performed by experienced pathologists according to the modified Marsh grading system.Results:The most common pathological grade of duodenal bulb(50.0%)and descending part of the duodenum(45.5%)was MarshⅢc,while those of terminal ileum was MarshⅢa(63.6%).All of the bulb biopsies,95.5%of the descending part and 72.7%of the terminal ileum biopsies showed characteristic histological changes of celiac disease.Mucosal pathology was patchy in 7 patients,of which one patient was duodenal bulb and terminal ileum involved,and 6 were duodenum involved only.Fifteen patients had diffuse small intestinal mucosal pathology involving duodenal bulb,descending part and terminal ileum,of which 4 patients showed concordant histology(the same Marsh grade in duodenal bulb,descending part and terminal ileum)and 11 patients showed discordant histology.In 18 patients(81.8%),duodenum was the only affected site or duodenum showed more serious mucosal lesions compared with terminal ileum.Conclusions:Adult celiac disease may affect the whole small intestine,and the mucosal involvement may be patchy,which highlights the importance of taking small intestinal biopsies from multiple sites repeatedly in the diagnostic work‑up of celiac disease.