Macaigne Gilles, Lahmek Pierre, Locher Christophe, Boivin Jean François, Lesgourgues Bruno, Yver Mathieu, Costes Laurent, Alsamad I Abd, Cucherousset Joel, Charpignon Claire, Guyot Hélène, Lambaré Bénédicte, Ghilain Jean-Michel, Calès Valérie, de Montigny-Lenhardt Stéphanie, Bellaïche Guy, Pariente Alexandre, Nahon Stéphane
Service d'hépato-gastroentérologie, centre hospitalier de Marne-la-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France.
Limeil Brévanne, France.
Clin Res Hepatol Gastroenterol. 2017 Jun;41(3):333-340. doi: 10.1016/j.clinre.2016.12.008. Epub 2017 Feb 16.
To determinate the topographical distribution of key diagnostic histological features of lymphocytic colitis (LC) and collagenous colitis (CC) and to establish what correlations may exist between the histological findings and the causes and severity of MC.
Patients with MC were included in a prospective multicentre French study from September 2010 to October 2012. MC was diagnosed by performing total colonoscopy with multiple biopsies of the rectum and colon collected in separate jars and analyzed separately for each site (descending and sigmoid colon, transverse colon, ascending colon). CC was defined as a subepithelial collagen layer>10μm thick and LC as an intraepithelial lymphocyte (IEL) count>20 lymphocytes per 100 epithelial cells without any associated thickening of the subepithelial collagen.
Ninety-five patients, 69 with LC 26 and with CC, were included in the analysis. The sensitivity of the biopsies for diagnosing MC was maximum in the transverse colon and minimum in the rectum. Rectal and left colonic biopsies resulted in the diagnosis of CC and CL in 93% and 94% of cases, respectively. All the remaining cases of MC were diagnosed by performing additional biopsies beyond the splenic flexure. In patients with LC, a higher rate of IELs was associated with the absence of abdominal pain (P=0.01) and a shorter duration of diarrhea (P=0.001). In patients with CC, a lower level of collagen thickness in the basement membrane was associated with the presence of an autoimmune disease (P=0.02).
More than 90% of cases of microscopic colitis were diagnosed in this study by performing rectal and left colonic biopsies.
确定淋巴细胞性结肠炎（LC）和胶原性结肠炎（CC）关键诊断组织学特征的地形分布，并确定组织学发现与微小结肠炎（MC）的病因和严重程度之间可能存在的相关性。
2010年9月至2012年10月，MC患者被纳入一项前瞻性多中心法国研究。通过进行全结肠镜检查并从直肠和结肠多处取材活检，将标本分别置于不同瓶中，对每个部位（降结肠和乙状结肠、横结肠、升结肠）进行单独分析来诊断MC。CC定义为上皮下胶原层厚度>10μm，LC定义为每100个上皮细胞中上皮内淋巴细胞（IEL）计数>20个淋巴细胞，且上皮下胶原无任何相关增厚。
95例患者纳入分析，其中69例为LC，26例为CC。活检诊断MC的敏感性在横结肠最高，在直肠最低。直肠和左半结肠活检分别在93%和94%的病例中诊断出CC和CL。所有其余的MC病例通过在脾曲以外进行额外活检得以诊断。在LC患者中，较高的IEL率与无腹痛（P=0.01）和较短的腹泻持续时间（P=0.001）相关。在CC患者中，基底膜中胶原厚度较低与自身免疫性疾病的存在相关（P=0.02）。
本研究中通过直肠和左半结肠活检诊断出超过90%的微小结肠炎病例。
