Vidali Francesca, Di Sabatino Antonio, Broglia Francesco, Cazzola Paolo, Biancheri Paolo, Viera Francesca Torello, Vanoli Alessandro, Alvisi Costanza, Perego Maurizio, Corazza Gino R
First Department of Medicine, Centro per lo Studio e la Cura delle Malattie Infiammatorie Croniche Intestinali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Scand J Gastroenterol. 2010 Jun;45(6):684-9. doi: 10.3109/00365521003663662.
Recent evidence suggests the involvement of the upper gastrointestinal tract in ulcerative colitis (UC). By conducting a prospective controlled study, we explored the immunological abnormalities in the duodenal mucosa of UC patients.
Duodenal and colonic biopsies were collected from 24 corticosteroid-free UC patients and 21 controls. Colonization by Helicobacter pylori and positivity for anti-endomysial antibodies was an exclusion criteria. The severity of duodenal and colonic inflammation was determined by endoscopic and histologic scores. Morphometry was performed to measure the surface area to volume ratio (SV). Duodenal CD3(+) and CD8(+) intraepithelial lymphocytes (IELs) and lamina propria mononuclear cells (LPMCs) were detected by immunohistochemistry.
Fifteen UC patients and 14 controls were Helicobacter pylori and anti-endomysial antibody negative and were thus included in the study. Microscopic duodenitis was reported in 4 of the 15 UC patients (26.6%), and in none of the controls. A significantly higher number of CD3(+) and CD8(+) IELs and LPMCs was found in UC patients than in controls. A significant positive correlation between the percentage of both CD3(+) and CD8(+) IELs and disease activity was found in UC patients. SV was significantly reduced in UC patients compared to controls, and inversely correlated with the percentage of CD8(+) IELs.
The duodenum of UC patients is infiltrated by a higher number of CD8(+) IELs which correlates with the degree of villous flattening and disease activity, but not with extent of the colonic lesions. Further studies are needed to clarify whether the duodenum is a target organ in UC.
近期证据表明上消化道参与了溃疡性结肠炎（UC）的发病过程。通过开展一项前瞻性对照研究，我们探究了UC患者十二指肠黏膜中的免疫异常情况。
收集了24例未使用皮质类固醇的UC患者及21例对照者的十二指肠和结肠活检组织。排除幽门螺杆菌定植及抗肌内膜抗体阳性的情况。通过内镜和组织学评分确定十二指肠和结肠炎症的严重程度。进行形态测量以测定表面积与体积比（SV）。采用免疫组织化学法检测十二指肠CD3(+)和CD8(+)上皮内淋巴细胞（IEL）及固有层单核细胞（LPMC）。
15例UC患者和14例对照者幽门螺杆菌及抗肌内膜抗体均为阴性，因此纳入本研究。15例UC患者中有4例（26.6%）报告有微观十二指肠炎症，而对照者中无一例出现。UC患者中CD3(+)和CD8(+) IEL及LPMC的数量显著高于对照者。在UC患者中，CD3(+)和CD8(+) IEL的百分比与疾病活动度之间存在显著正相关。与对照者相比，UC患者的SV显著降低，且与CD8(+) IEL的百分比呈负相关。
UC患者的十二指肠中有较多的CD8(+) IEL浸润，这与绒毛扁平化程度及疾病活动度相关，但与结肠病变范围无关。需要进一步研究以阐明十二指肠是否为UC的靶器官。
