Torrente Franco, Anthony Andrew, Heuschkel Robert B, Thomson Michael A, Ashwood Paul, Murch Simon H
The Centre for Paediatric Gastroenterology, Department of Histopathology, Royal Free & University College Medical School, London.
Am J Gastroenterol. 2004 Apr;99(4):598-605. doi: 10.1111/j.1572-0241.2004.04142.x.
Immunohistochemistry allowed recent recognition of a distinct focal gastritis in Crohn's disease. Following reports of lymphocytic colitis and small bowel enteropathy in children with regressive autism, we aimed to see whether similar changes were seen in the stomach. We thus studied gastric antral biopsies in 25 affected children, in comparison to 10 with Crohn's disease, 10 with Helicobacter pylori infection, and 10 histologically normal controls. All autistic, Crohn's, and normal patients were H. pylori negative.
Snap-frozen antral biopsies were stained for CD3, CD4, CD8, gammadelta T cells, HLA-DR, IgG, heparan sulphate proteoglycan, IgM, IgA, and C1q. Cell proliferation was assessed with Ki67.
Distinct patterns of gastritis were seen in the disease states: diffuse, predominantly CD4+ infiltration in H. pylori, and focal-enhanced gastritis in Crohn's disease and autism, the latter distinguished by striking dominance of CD8+ cells, together with increased intraepithelial lymphocytes in surface, foveolar and glandular epithelium. Proliferation of foveolar epithelium was similarly increased in autism, Crohn's disease and H. pylori compared to controls. A striking finding, seen only in 20/25 autistic children, was colocalized deposition of IgG and C1q on the subepithelial basement membrane and the surface epithelium.
These findings demonstrate a focal CD8-dominated gastritis in autistic children, with novel features. The lesion is distinct from the recently recognized focal gastritis of Crohn's disease, which is not CD8-dominated. As in the small intestine, there is epithelial deposition of IgG.
免疫组织化学使人们最近认识到克罗恩病中存在一种独特的局灶性胃炎。在有退行性自闭症的儿童中报告了淋巴细胞性结肠炎和小肠肠病后，我们旨在观察胃部是否也有类似变化。因此，我们研究了25名患病儿童的胃窦活检样本，并与10名克罗恩病患者、10名幽门螺杆菌感染患者以及10名组织学正常的对照者进行比较。所有自闭症、克罗恩病和正常患者的幽门螺杆菌检测均为阴性。
将速冻的胃窦活检样本进行CD3、CD4、CD8、γδT细胞、HLA-DR、IgG、硫酸乙酰肝素蛋白聚糖、IgM、IgA和C1q染色。用Ki67评估细胞增殖情况。
在不同疾病状态下观察到了不同的胃炎模式：幽门螺杆菌感染时为弥漫性、以CD4+浸润为主，克罗恩病和自闭症时为局灶性强化胃炎，后者以CD8+细胞显著占优势为特征，同时表面、小凹和腺上皮中的上皮内淋巴细胞增多。与对照组相比，自闭症、克罗恩病和幽门螺杆菌感染患者的小凹上皮增殖同样增加。一个仅在20/25名自闭症儿童中出现的显著发现是，IgG和C1q在基底膜下和表面上皮共定位沉积。
这些发现表明自闭症儿童存在一种以CD8为主的局灶性胃炎，具有新的特征。该病变不同于最近认识到的克罗恩病局灶性胃炎，后者不是以CD8为主。与小肠一样，存在IgG的上皮沉积。
