Meinzer Ulrich, Ideström Maja, Alberti Corinne, Peuchmaur Michel, Belarbi Nadia, Bellaïche Marc, Mougenot Jean-François, Cézard Jean-Pierre, Finkel Yigael, Hugot Jean-Pierre
Department of Paediatric Gastroenterology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France.
Inflamm Bowel Dis. 2005 Jul;11(7):639-44. doi: 10.1097/01.mib.0000165114.10687.bf.
Lymphoid follicles (LFs) have been suggested to play a role at the early stage of Crohn's disease (CD) lesions. In the small bowel, LFs are grouped, forming Peyer's patches, which develop early in fetal life, grow in size and number until puberty, and undergo involution. In contrast, colonic LFs are isolated and undergo little change during life. As a result, if LFs play a role in the occurrence of CD lesions, the distribution of ileal and colonic lesions is expected to be altered in small children.
Medical records of 2 independent French (n = 136) and Swedish (n = 55) cohorts of consecutive pediatric CD were reviewed. Disease sites and age of onset were recorded, and the age-dependent probability to develop ileal lesions was computed. The CARD15/NOD2 genotype was also analyzed when available (n = 99).
The curves of disease occurrence were significantly different in case of CD with or without ileal lesions (P < 0.0001). At the age of 8 years, the probability (95% confidence interval) of small bowel involvement was 0.19 (0.07-0.39). It increased until 16 years of age to 0.61 (0.54-0.68). It was slightly higher in patients carrying 1 or more CARD15/NOD2 mutations [0.75 (0.55-0.89)] than in wild-type patients [0.46 (0.34-0.58)]. CARD15 mutations also influenced the age of onset of ileal disease (P < 0.02).
In children, ileal CD lesions are delayed compared with colonic lesions. This observation is in agreement with the previously proposed hypothesis of a pathophysiological role of Peyer's patches in ileal CD. The rarity of small bowel lesions should be a warning to be cautious when classifying chronic colitis in small children.
有研究表明淋巴滤泡（LFs）在克罗恩病（CD）病变的早期阶段发挥作用。在小肠中，淋巴滤泡聚集形成派尔集合淋巴结，其在胎儿期早期发育，大小和数量在青春期前不断增长，随后逐渐退化。相比之下，结肠淋巴滤泡是孤立的，在生命过程中变化很小。因此，如果淋巴滤泡在CD病变的发生中起作用，那么预计小儿回肠和结肠病变的分布会发生改变。
回顾了2个独立的法国队列（n = 136）和瑞典队列（n = 55）中连续的小儿CD患者的病历。记录疾病部位和发病年龄，并计算发生回肠病变的年龄依赖性概率。如有可用数据（n = 99），还分析了CARD15/NOD2基因型。
有或无回肠病变的CD患者疾病发生曲线存在显著差异（P < 0.0001）。8岁时，小肠受累的概率（95%置信区间）为0.19（0.07 - 0.39）。该概率在16岁时增加至0.61（0.54 - 0.68）。携带1个或更多CARD15/NOD2突变的患者[0.75（0.55 - 0.89）]的该概率略高于野生型患者[0.46（0.34 - 0.58）]。CARD15突变也影响回肠疾病的发病年龄（P < 0.02）。
在儿童中，回肠CD病变比结肠病变出现得晚。这一观察结果与先前提出的派尔集合淋巴结在回肠CD中具有病理生理作用的假说一致。小肠病变的罕见性应成为小儿慢性结肠炎分类时谨慎诊断的警示。
