Sullivan Katrina J, Wei Mike, Chernetsova Elizabeth, Hallani Soufiane, de Nanassy Joseph, Benchimol Eric I, Mack David R, Nasr Ahmed, El Demellawy Dina
Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada K1H 8L1.
Faculty of Medicine, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5.
Hum Pathol. 2017 Aug;66:167-176. doi: 10.1016/j.humpath.2017.06.006. Epub 2017 Jun 23.
Refractory ulcerative colitis (UC) occurs in patients who experience a severe disease manifestation that is unresponsive to medical therapy. The assessment of upper endoscopic microscopic findings and its correlation with refractory UC has not been fully studied in pediatric patients and is the focus of this study. Medical records of UC patients treated at a tertiary pediatric center between 2000 and 2014 were reviewed. Endoscopic biopsies of the upper gastrointestinal (GI) tract of patients meeting a priori inclusion criteria were compared between refractory UC patients and nonrefractory UC patients for active inflammation. Statistically significant differences were determined between groups, and tissues shown to have significant differences were further evaluated for their diagnostic performance. A total of 52 patients were included, 26 in each group. Significant differences were observed in intraepithelial neutrophil infiltration and percentage involvement of crypts/glands for the antrum, body, and duodenal bulb (P ≤ .001, .005, and .01 [intraepithelial neutrophil infiltration] and P = .001, .009, and .015 [% involvement], respectively). Microabscesses of mucosal glands/crypts were also experienced in a greater number of refractory UC patients in the stomach (ie, antrum and/or body of stomach; P = .005) and duodenum (ie, duodenum and/or duodenal bulb; P = .023). The sensitivity and specificity of upper GI tissues to predict refractory UC were moderate, with sensitivities ranging from 38% to 67% and specificities ranging from 81% to 100%. Our results suggest that children with refractory UC are more likely to have active inflammation in the upper GI tract, and thus, this may represent a predictor of responsiveness to current medical therapy.
难治性溃疡性结肠炎（UC）发生于那些患有严重疾病表现且对药物治疗无反应的患者。小儿患者中上消化道内镜微观检查结果及其与难治性UC的相关性尚未得到充分研究，而这正是本研究的重点。回顾了2000年至2014年在一家三级儿科中心接受治疗的UC患者的病历。在符合预先设定纳入标准的患者中，比较了难治性UC患者和非难治性UC患者上消化道（GI）内镜活检的活动性炎症情况。确定了两组之间的统计学显著差异，并对显示有显著差异的组织进行了诊断性能的进一步评估。总共纳入了52例患者，每组26例。在胃窦、胃体和十二指肠球部的上皮内中性粒细胞浸润以及隐窝/腺体受累百分比方面观察到显著差异（上皮内中性粒细胞浸润分别为P≤0.001、0.005和0.01，受累百分比分别为P = 0.001、0.009和0.015）。更多难治性UC患者在胃（即胃窦和/或胃体；P = 0.005）和十二指肠（即十二指肠和/或十二指肠球部；P = 0.023）出现黏膜腺体/隐窝微脓肿。上消化道组织预测难治性UC的敏感性和特异性中等，敏感性范围为38%至67%，特异性范围为81%至100%。我们的结果表明，难治性UC患儿更有可能在上消化道出现活动性炎症，因此，这可能代表了对当前药物治疗反应性的一个预测指标。
