Department of Hepatogastroenterology and †Pathology, CHU UCL Mont-Godinne, Mont-Godinne, Belgium.
Inflamm Bowel Dis. 2013 Sep;19(10):2084-90. doi: 10.1097/MIB.0b013e3182971cec.
Increased lymphatic vessel (LV) density has been found in uninflamed intestinal wall of patients with Crohn's disease (CD). The goal of the study was to search for an association between LV density in the proximal ileal resection margin at the time of surgery and endoscopic recurrence.
Ileocolonic resection specimens were obtained from 28 CD patients and 10 control subjects. The ileal proximal uninflamed section was used for the histological quantification of LV using immunohistochemistry with D2-40 antibody in the mucosa and submucosa. Quantification of LV was performed in 8 consecutive fields and was blinded to recurrence score. Patients were divided into 2 groups based on the presence (Rutgeerts score, i3/i4) (R+) or absence (Rutgeerts score, i0/i1) (R-) of endoscopic recurrence 1 year after the surgery. All patients were free of immunomodulators or biologics between surgery and postoperative endoscopy.
Median LV density was lower in control subjects than in CD patients in the mucosa (4.5%; interquartile range [IQR], 3.6-5.3 versus 5.9%; IQR, 4.2-8.5; P = 0.04) and submucosa (2.4%; IQR, 1.9-3.6 versus 5.7%; IQR, 4.3-6.9; P < 0.01). R- patients had a higher LV density in the proximal resection margin at surgery than R+ patients, both in the mucosa (8.5%; IQR, 6.5-10.3 versus 4.4%; IQR, 3.1-6.1; P < 0.01) and in the submucosa (6.3%; IQR, 5.5-9.3 versus 5.3%; IQR, 3.4-5.9; P = 0.03). Mucosal LV density greater than 7% predicted the absence of endoscopic recurrence at 1 year, with a sensitivity of 81% and a specificity of 75%.
Decreased LV density is associated with high risk of endoscopic recurrence after surgery. Therapies that improve lymphatic flow in the gut may reduce the incidence of endoscopic recurrence.
在克罗恩病（CD）患者未发炎的肠壁中发现淋巴管密度增加。本研究的目的是探讨手术时近端回肠切除缘淋巴管密度与内镜复发之间的关系。
从 28 例 CD 患者和 10 例对照中获取回结肠切除术标本。使用 D2-40 抗体对回肠未发炎的近端节段进行免疫组化，在黏膜和黏膜下层定量测量 LV。在 8 个连续视野中进行 LV 定量，且对复发评分进行盲法分析。根据术后 1 年内镜复发（Rutgeerts 评分，i3/i4）（R+）或无内镜复发（Rutgeerts 评分，i0/i1）（R-）将患者分为 2 组。手术与术后内镜检查之间所有患者均未使用免疫调节剂或生物制剂。
与 CD 患者相比，对照组黏膜中 LV 密度较低（4.5%；四分位距[IQR]，3.6-5.3 比 5.9%；IQR，4.2-8.5；P=0.04）和黏膜下层（2.4%；IQR，1.9-3.6 比 5.7%；IQR，4.3-6.9；P<0.01）。R-患者的手术近端切除缘 LV 密度高于 R+患者，黏膜（8.5%；IQR，6.5-10.3 比 4.4%；IQR，3.1-6.1；P<0.01）和黏膜下层（6.3%；IQR，5.5-9.3 比 5.3%；IQR，3.4-5.9；P=0.03）。黏膜 LV 密度大于 7%预测 1 年内无内镜复发，敏感性为 81%，特异性为 75%。
LV 密度降低与术后内镜复发风险增加相关。改善肠道淋巴流量的治疗方法可能会降低内镜复发的发生率。
