Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
Hum Pathol. 2013 Aug;44(8):1624-9. doi: 10.1016/j.humpath.2013.01.013. Epub 2013 Apr 6.
Collagenous sprue is a rare enteropathy whose etiology is unknown, but immune-mediated mechanisms are one of several possibilities. However, the role of immunoglobulin G4 (IgG4)-positive plasma cells has not been studied in collagenous sprue. Endoscopic biopsies from the duodenum with a histologic diagnosis of collagenous sprue (n = 40 from 35 patients), celiac disease (n = 25), peptic duodenitis (n = 15) and normal duodenum (n = 25) were immunohistochemically stained with IgG4 and CD138 antibodies. For each case, the quantities of IgG4- and CD138-positive plasma cells in the lamina propria were estimated by averaging the number in 3 high-power fields (hpf) that showed the highest concentration. Nine of forty collagenous sprue samples showed a mean of 10 or more IgG4 plasma cells per hpf, whereas none of the duodenal control biopsies showed 10 or more IgG4 plasma cells per hpf: celiac disease (P = .01), peptic duodenitis (P = .05), and normal duodenum (P = .01). Our study demonstrates that increased IgG4-positive plasma cells are present in a subset (23%) of collagenous sprue and may play a role in its pathogenesis.
胶原性腹泻是一种罕见的肠病，其病因不明，但免疫介导的机制是多种可能性之一。然而，IgG4 阳性浆细胞在胶原性腹泻中的作用尚未得到研究。对组织学诊断为胶原性腹泻（35 例患者中的 40 例）、乳糜泻（25 例）、消化性十二指肠炎（15 例）和正常十二指肠（25 例）的十二指肠内镜活检进行 IgG4 和 CD138 抗体免疫组织化学染色。对于每个病例，通过平均 3 个高倍视野（hpf）中显示最高浓度的 IgG4 和 CD138 阳性浆细胞的数量来估计固有层中 IgG4 和 CD138 阳性浆细胞的数量。40 个胶原性腹泻样本中有 9 个样本每 hpf 有 10 个或更多 IgG4 浆细胞，而十二指肠对照活检中没有一个样本每 hpf 有 10 个或更多 IgG4 浆细胞：乳糜泻（P =.01），消化性十二指肠炎（P =.05）和正常十二指肠（P =.01）。我们的研究表明，在胶原性腹泻的一个亚组（23%）中存在 IgG4 阳性浆细胞增多，可能在其发病机制中起作用。
