Boyle Brendan, Collins Margaret H, Wang Zhu, Mack David, Griffiths Anne, Sauer Cary, Markowitz James, LeLeiko Neal, Keljo David, Rosh Joel, Baker Susan S, Pfefferkorn Marian, Heyman Melvin, Patel Ashish, Baldassano Robert, Noe Joshua, Rufo Paul, Kugathasan Subra, Walters Thomas, Denson Lee, Hyams Jeffrey
*Nationwide Children's Hospital, Columbus †Cincinnati Children's Hospital Medical Center, Cincinnati, OH ‡Connecticut Children's Medical Center, Hartford, CT §Children's Hospital of Eastern Ontario, Ottawa ∥Hospital for Sick Children, Toronto, ON, Canada ¶Emory Children's Center, Atlanta, GA #Cohen Children's Medical Center, New Hyde Park ‡‡Goryeb Children's Hospital/Atlantic Health, Morristown §§Women & Children's Hospital of Buffalo WCHOB, Buffalo, NY **Hasbro Children's Hospital, Providence, RI ††Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA ∥∥Riley Children's Hospital Indiana University School of Medicine, Indianapolis, IN ¶¶University of California, San Francisco, CA ##UT Southwestern, Dallas, TX ***Children's Hospital of Philadelphia, Philadelphia, PA †††Medical College of Wisconsin, Milwaukee, WI ‡‡‡Boston Children's Hospital, Boston, MA.
Am J Surg Pathol. 2017 Nov;41(11):1491-1498. doi: 10.1097/PAS.0000000000000939.
To characterize rectal histology in an inception cohort of children newly diagnosed with ulcerative colitis (UC) and to explore its relationship with clinical indices of disease severity. The PROTECT (Predicting Response to Standardized Pediatric Colitis Therapy) Study enrolled children 17 years of age and younger newly diagnosed with UC. Baseline rectal biopsies were evaluated for acute and chronic inflammation, eosinophilic inflammation (peak eosinophil count > 32 eosinophils/high powered field, eosinophilic cryptitis or abscesses), and architectural/nonarchitectural chronic changes. Correlation with clinical indices including Mayo endoscopy subscore and Pediatric Ulcerative Colitis Activity Index was performed. Rectal biopsies from 369 patients (mean age, 12.9±3.1 y, 50% female) were reviewed. Cryptitis was found in 89%, crypt abscesses in 25%, and eosinophilic inflammation in 58%. Crypt distortion/atrophy was present in 98% of specimens. Higher grades of acute and chronic inflammation were associated with the presence of basal plasmacytosis (P<0.0001), basal lymphoid aggregates (P<0.0001), and surface villiform changes (P<0.0001). A severe Mayo endoscopy subscore was most common among those with severe acute and chronic inflammation, although this relationship was not linear. Severe Pediatric Ulcerative Colitis Activity Index scores were associated with the absence of or only mild eosinophilic inflammation (<32 eosinophils/high powered field) (P<0.03) and the presence of surface villiform changes (P<0.005). Acute and chronic inflammation, eosinophilic inflammation and chronic changes are common in children newly diagnosed with UC. The clinical and biological implication of low to absent eosinophilic inflammation and the presence of surface villiform changes requires further study.
为了描述新诊断为溃疡性结肠炎（UC）的儿童起始队列中的直肠组织学特征，并探讨其与疾病严重程度临床指标的关系。PROTECT（预测标准化儿科结肠炎治疗反应）研究纳入了17岁及以下新诊断为UC的儿童。对基线直肠活检进行急性和慢性炎症、嗜酸性粒细胞炎症（嗜酸性粒细胞峰值计数>32个嗜酸性粒细胞/高倍视野、嗜酸性隐窝炎或脓肿）以及结构/非结构慢性改变的评估。进行了与包括梅奥内镜亚评分和儿童溃疡性结肠炎活动指数在内的临床指标的相关性分析。对369例患者（平均年龄12.9±3.1岁，50%为女性）的直肠活检进行了回顾。发现隐窝炎的占89%，隐窝脓肿的占25%，嗜酸性粒细胞炎症的占58%。98%的标本存在隐窝变形/萎缩。更高等级的急性和慢性炎症与基底浆细胞增多（P<0.0001）、基底淋巴样聚集（P<0.0001）和表面绒毛状改变（P<0.0001）有关。严重的梅奥内镜亚评分在急性和慢性炎症严重的患者中最为常见，尽管这种关系不是线性的。严重的儿童溃疡性结肠炎活动指数评分与无或仅有轻度嗜酸性粒细胞炎症（<32个嗜酸性粒细胞/高倍视野）（P<0.03）以及表面绒毛状改变的存在（P<0.005）有关。急性和慢性炎症、嗜酸性粒细胞炎症和慢性改变在新诊断为UC的儿童中很常见。嗜酸性粒细胞炎症低或无以及表面绒毛状改变的临床和生物学意义需要进一步研究。
