Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
Am J Gastroenterol. 2011 Feb;106(2):264-71. doi: 10.1038/ajg.2010.412. Epub 2010 Oct 26.
Mast cells may contribute to the pathogenesis of eosinophilic esophagitis (EoE), but their role in diagnosis is unknown. Our aim was to determine whether tryptase staining of esophageal mast cells differentiates EoE from gastroesophageal reflux disease (GERD) and has utility for diagnosis of EoE.
We performed a case-control study comparing patients with EoE, defined by consensus guidelines, to GERD patients with eosinophils on esophageal biopsy. Immunohistochemistry was performed with mast cell tryptase. The density (mast cells/mm2) and intensity (0-4 scale) of mast cell staining was compared between groups after masking the diagnosis. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to assess mast cell staining as both a stand-alone diagnostic test and an adjunctive assay with eosinophil counts.
Fifty-four EoE (mean age 24 years; 69% male; mean 146 eosinophils per high-power field (eos/hpf)) and 55 GERD (mean age 34 years; 60% male; mean 20 eos/hpf) patients were analyzed. The maximum epithelial tryptase density was higher in EoE than in GERD (162±87 mast cells/mm2 vs. 67±54; P<0.001). Mast cells were diffusely distributed throughout the biopsy in more EoE than GERD patients (41 vs. 7%; P<0.001). Tryptase density and eosinophil count were only weakly correlated (R2=0.09; P=0.002). The AUC was 0.84 for tryptase staining alone, and 0.96 for the combination of mast cells and eosinophils.
Patients with EoE have higher levels of tryptase-positive mast cells compared with GERD patients, improving the diagnostic value of biopsies beyond eosinophil counts alone. Mast cell tryptase may have utility as a diagnostic assay for EoE.
肥大细胞可能参与嗜酸性食管炎（EoE）的发病机制，但它们在诊断中的作用尚不清楚。我们的目的是确定食管肥大细胞的类胰蛋白酶染色是否能区分 EoE 与胃食管反流病（GERD），并有助于 EoE 的诊断。
我们进行了一项病例对照研究，比较了根据共识指南定义的 EoE 患者与食管活检有嗜酸性粒细胞的 GERD 患者。采用肥大细胞类胰蛋白酶免疫组织化学染色。在掩盖诊断的情况下，比较两组之间的肥大细胞染色密度（肥大细胞/mm2）和强度（0-4 级）。构建受试者工作特征（ROC）曲线，并计算曲线下面积（AUC），以评估肥大细胞染色作为独立诊断试验和与嗜酸性粒细胞计数联合检测的辅助试验。
共分析了 54 例 EoE（平均年龄 24 岁；69%为男性；平均每高倍镜视野 146 个嗜酸性粒细胞/eos/hpf）和 55 例 GERD（平均年龄 34 岁；60%为男性；平均每高倍镜视野 20 个嗜酸性粒细胞/eos/hpf）患者。EoE 的上皮细胞类胰蛋白酶密度高于 GERD（162±87 个肥大细胞/mm2 比 67±54；P<0.001）。与 GERD 患者相比，更多的 EoE 患者的肥大细胞呈弥漫性分布（41%比 7%；P<0.001）。类胰蛋白酶密度和嗜酸性粒细胞计数仅呈弱相关（R2=0.09；P=0.002）。单独使用类胰蛋白酶染色的 AUC 为 0.84，而联合使用肥大细胞和嗜酸性粒细胞的 AUC 为 0.96。
与 GERD 患者相比，EoE 患者的类胰蛋白酶阳性肥大细胞水平更高，除了嗜酸性粒细胞计数外，还提高了活检的诊断价值。类胰蛋白酶可能可作为 EoE 的诊断检测。
