Kaur Bilkhoo Harpreet, Ducruet Thierry, Marchand Valérie, Deslandres Colette, Djemli Anissa, Dal Soglio Dorothée, Patey Natalie
*Département de Pathologie †Unité de Recherche clinique appliquée ‡Département de Gastroentérologie Hépatologie et Nutrition §Département de Biochimie, CHU Sainte-Justine, Montréal, QC, Canada.
J Pediatr Gastroenterol Nutr. 2016 May;62(5):734-8. doi: 10.1097/MPG.0000000000001026.
The diagnosis of coeliac disease (CD) remains sometimes difficult because the histological criteria are not fully met. The aim of this study was to refine histological diagnostic criteria of CD.
One hundred seventy-five duodenal bulb D1 (n = 79) and duodenal D2 (n = 96) biopsies of 96 patients with CD (58 girls, mean age 7 years), 135 normal D2 biopsies (69 girls, mean age 12 years), and 64 D2 biopsies of other digestive disorders (DDs) (39 girls, mean age 13 years) obtained from children during a period of 4 years were reviewed.
Interobserver agreement was greater for the classification of Corazza-Villanacci than for Marsh-Oberhuber (κ = 0.812 vs κ = 0.409, respectively). Between 40 and 70 intraepithelial lymphocytes (IELs) per 100 epithelial cells (ECs), 32% of patients were CD, whereas 50% had other DD. Above 70 IELs per 100 EC, 53% were CD, and only 6% had other DD. In CD, IELs were significantly located above EC nuclei compared with other DD, (12 IELs/100 EC vs 2 IELs/100 EC, respectively). In 21% of CD cases, D2 were normal and the diagnosis could only be made on D1. Finally, 6% of CD cases showed isolated increase of IELs in D1 without architectural modification.
D1 allowed diagnosis of CD in 21% of cases and IEL >70 per 100 EC correlated strongly with CD. Between 40 and 70 IELs per 100 EC, CD is very likely but other DD must be considered. Finally, the preferential localisation of IELs above EC nuclei favours CD, and increased IEL in D1 may be the sole abnormality.
由于组织学标准未完全满足，乳糜泻（CD）的诊断有时仍很困难。本研究的目的是完善CD的组织学诊断标准。
回顾了4年间从儿童中获取的96例CD患者（58名女孩，平均年龄7岁）的175份十二指肠球部D1活检标本（n = 79）和十二指肠D2活检标本（n = 96）、135份正常D2活检标本（69名女孩，平均年龄12岁）以及64份其他消化系统疾病（DDs）的D2活检标本（39名女孩，平均年龄13岁）。
观察者间对Corazza-Villanacci分类的一致性高于Marsh-Oberhuber分类（κ分别为0.812和0.409）。每100个上皮细胞（ECs）中有40至70个上皮内淋巴细胞（IELs）时，32%的患者为CD，而50%患有其他DD。每100个ECs中IELs超过70个时，53%为CD，只有6%患有其他DD。在CD中，与其他DD相比，IELs显著位于EC细胞核上方（分别为12个IELs/100个EC和2个IELs/100个EC）。在21%的CD病例中，D2正常，诊断只能基于D1做出。最后，6%的CD病例显示D1中IELs单独增加而无结构改变。
D1在21%的病例中可诊断CD，每100个EC中IEL>70与CD密切相关。每100个EC中有40至70个IELs时，很可能是CD，但必须考虑其他DD。最后，IELs优先定位于EC细胞核上方支持CD的诊断，且D1中IELs增加可能是唯一异常。
