活动期溃疡性结肠炎活检黏膜的病理组织学特征、分级及其与疾病程度的关系

Pathohistologic features and grading of biopsy mucosae and their correlation with disease severity of active ulcerative colitis

目的 研究活动期溃疡性结肠炎 (UC)活检黏膜的病理组织学特征、分级及其与疾病程度的关系 ,为UC诊断提供病理学依据。方法 应用大样本 (133例 )进行前瞻性研究 ,按UC的严重程度将 133例UC患者进行分组研究 ,应用HE染色进行病理形态学分析和分级。结果 活检黏膜的病理特征是 :上皮细胞间的中性粒细胞 (10 0 .0 % )、嗜酸性粒细胞 (99.2 % )、浆细胞 (91.7% )与淋巴细胞(75 .2 % )的浸润和淋巴滤泡的形成 (72 .2 % ) ,固有层小血管炎 (6 3.9% )和灶性出血 (6 8.4 % ) ,黏膜隐窝脓肿 (43.6 % )、腺体异常 (44 .4 % )、腺体杯状细胞减少或消失 (18.8% )、上皮细胞再生 (36 .8% )、非典型增生 (2 8.6 % )和肉芽组织的形成 (42 .9% )。随着UC严重程度的增加 ,小血管炎、血管壁坏死、腺体异常、不典型增生、杯状细胞减少或消失、肉芽组织、纤维细胞增生和隐窝脓肿发生率显著升高。淋巴细胞增生、淋巴滤泡形成、嗜酸性粒细胞和浆细胞浸润 ,三组间差异均无显著性。轻度UC以Ⅰ、Ⅱ级病变为主 ,中度UC以Ⅱ、Ⅲ级病变为主 ,重度UC以Ⅲ级、Ⅳ级病变为主 ;轻、中、重度间各分级 ,均差异有显著性。结论 活动期UC活检黏膜具有一定的病理特征 ,其部分指标与组织学分级能反映活动期UC的严重性和活动性。

Objective To investigate the pathohistologic features and grading of biopsy mucosae and their correlation with disease severity of active ulcerative colitis(UC). Methods A prospective study was conducted in 133 patients with UC who were divided into three groups based on the degree of severity. Pathologic morphometry and grading with HE staining sections were analyzed. Results Pathologic features of active UC: there were neutrophilic leukocytes (100.0%), eosinophils (99.2%), plasmacytes(91.7%) and lymphocytes (75.2%) infiltration among mucosal epithelial cells, and lymphoid follicular formation(72.2%) and small vessels inflammation(63.9%) and focal hemorrhage(68.4%) in lamina propria. There were crypt abscesses(43.6%), glandular abnormalities (44.4%), goblet cell depletion (18.8%), epithelial cell regeneration (36.8%) , atypical hyperplasia (28.6%) and granulation tissue formation (42.9%) in mucosae. With the increase of severity of UC, there was a significant increasing incidence of small vessel inflammation, fiberoid necrosis of vessel wall, glandular abnormality, epithelial cell regeneration, atypical hyperplasia, goblet cell depletion, granulation tissue formation, fiber tissue hyperplasia, and crypt abscess. There was no significant difference of the incidence of lymphocyte hyperplasia, lymphoid follicular formation, eosinophil and plasmacyte infiltration between the groups. Mild UC was mainly characterized by the lesions of Grade Ⅰ and Ⅱ, moderate UC by those of Grade Ⅱ and Ⅲ and severe UC by those of Grade Ⅲ and Ⅳ. There were significant differences of grades among mild, moderate and severe UC. Conclusions There were some pathologic characters in active UC. The partial of markers and histological gradings can reflect the severity and activity of active UC.