Graham M F, Diegelmann R F, Elson C O, Lindblad W J, Gotschalk N, Gay S, Gay R
Department of Pediatrics (Children's Medical Center), Medical College of Virginia, Richmond.
Gastroenterology. 1988 Feb;94(2):257-65. doi: 10.1016/0016-5085(88)90411-8.
The collagen content and the relative amount of collagen types were quantitated in control intestine as well as in both inflamed and strictured intestine resected from patients with Crohn's disease. The major collagen type in control intestine was type I (68%), followed by types III (20%) and V (12%). In strictured intestine both collagen content and the relative amount of type V collagen were significantly increased compared with control intestine. Histologic studies demonstrated that in strictured specimens there was a striking proliferation of smooth muscle cells of the muscularis mucosae associated with an accumulation of collagen in the submucosa. The thickness of the muscularis propria was also increased. Immunohistochemical studies demonstrated small amounts of type V collagen in the submucosa of control bowel. In contrast, large amounts of type V collagen were seen in the fibrotic, expanded submucosa of strictured bowel, particularly in the areas where smooth muscle cells of the muscularis mucosae had proliferated. Intestinal strictures in Crohn's disease are therefore characterized by an accumulation of collagen, a proliferation of smooth muscle cells, and an increase in type V collagen, a collagen type produced in relatively large amounts by smooth muscle cells. These changes appear to result in both a loss of the normal compliance of the intestine and a thickening of the intestine wall, resulting ultimately in the intestinal obstruction so frequently seen in patients with Crohn's disease.
对取自克罗恩病患者的对照肠段以及发炎和狭窄肠段的胶原蛋白含量和胶原蛋白类型的相对含量进行了定量分析。对照肠段中的主要胶原蛋白类型为I型（68%），其次是III型（20%）和V型（12%）。与对照肠段相比，狭窄肠段中的胶原蛋白含量和V型胶原蛋白的相对含量均显著增加。组织学研究表明，在狭窄标本中，黏膜肌层的平滑肌细胞显著增殖，同时黏膜下层有胶原蛋白积聚。固有肌层厚度也增加。免疫组织化学研究显示，对照肠段黏膜下层有少量V型胶原蛋白。相比之下，在狭窄肠段纤维化、扩张的黏膜下层可见大量V型胶原蛋白，尤其是在黏膜肌层平滑肌细胞增殖的区域。因此，克罗恩病的肠道狭窄的特征是胶原蛋白积聚、平滑肌细胞增殖以及V型胶原蛋白增加，V型胶原蛋白是由平滑肌细胞大量产生的一种胶原蛋白类型。这些变化似乎导致肠道正常顺应性丧失和肠壁增厚，最终导致克罗恩病患者常见的肠梗阻。
