De Las Casas L E, Finley J L
East Carolina University, School of Medicine, Department of Pathology and Laboratory Medicine, Brody Medical Sciences Building, Greenville, NC 27858-4354, USA.
Histopathology. 1999 Sep;35(3):267-70. doi: 10.1046/j.1365-2559.1999.00702.x.
Microangiopathic changes in the gastrointestinal tract of patients with diabetes mellitus are frequently mentioned in the clinical literature. To our knowledge, pathological studies documenting these changes in bowel biopsies have not been previously reported. In this report, we describe striking duodenal biopsy findings of diabetic microangiopathy in a patient with long-standing insulin-dependent diabetes mellitus and chronic diarrhoea.
The diagnosis was based on the histopathological and immunohistochemical findings in the appropriate clinical setting. Blood vessels within the duodenum displayed prominent mural thickening and luminal narrowing secondary to accumulation of hyaline material, which was periodic acid-Schiff positive and intensely stained with monoclonal antibodies against type IV collagen.
This is the first report of diabetic microangiopathy in a bowel biopsy. The pathogenesis, specificity and significance of these angiopathic changes, controversies about diabetic microangiopathy in the gastrointestinal tract, and the association with hypertension are discussed.
糖尿病患者胃肠道的微血管病变在临床文献中经常被提及。据我们所知，此前尚未有关于肠活检中记录这些变化的病理学研究报告。在本报告中，我们描述了一位长期依赖胰岛素治疗的糖尿病和慢性腹泻患者十二指肠活检中显著的糖尿病微血管病变发现。
诊断基于在适当临床背景下的组织病理学和免疫组织化学发现。十二指肠内的血管显示出明显的壁增厚和管腔狭窄，这是由于透明物质积聚所致，该物质过碘酸希夫染色呈阳性，并且用抗IV型胶原单克隆抗体染色强烈。
这是肠活检中糖尿病微血管病变的首次报告。讨论了这些血管病变的发病机制、特异性和意义、关于胃肠道糖尿病微血管病变的争议以及与高血压的关联。
