Malfertheiner P, Bode G, Mader U, Baczako K, Stanescu A, Ditschuneit H
Klin Wochenschr. 1985 Oct 15;63(20):1061-70. doi: 10.1007/BF01739674.
To evaluate and further characterize duodenal ulcer healing macroscopical, histological, and ultrastructural criteria were examined in 24 patients with active duodenal ulcer disease under two different treatment schedules. After the endoscopic confirmation of an active duodenal ulcer patients were randomly assigned to treatment with either an antacid (group A) or with an H2 blocker (group B). Tissue specimen were taken during endoscopy from the margin and 1 cm from the ulcer before therapy and from the ulcer scar or the previous ulcerated region after a 4 week treatment. A macroscopic ulcer healing by endoscopic criteria was confirmed in 83% of the patients in group A and in 83% of group B. The prominent histological feature of duodenal ulcer healing was a significant increase of PAS positive epithelial cells. Ultrastructural changes of the duodenal mucosa were still present at the end of the treatment, even in the presence of complete macroscopic healing. The ultrastructural healing process shows constant patterns independent from the type of treatment. The characteristic morphological feature by electron microscopy of the healing duodenal ulcer is the appearance of a metaplastic mucus secreting cell of the antrum-type. The devastated mucous structure during the ulcerative phase regains the normal net-like structure after 4 weeks therapy.
为了评估并进一步描述十二指肠溃疡愈合的宏观、组织学和超微结构标准，我们对24例活动性十二指肠溃疡疾病患者按照两种不同治疗方案进行了检查。在内镜确诊为活动性十二指肠溃疡后，患者被随机分为两组，分别接受抗酸剂治疗（A组）或H2受体阻滞剂治疗（B组）。在内镜检查时，于治疗前从溃疡边缘及距溃疡1厘米处取材，治疗4周后从溃疡瘢痕或先前溃疡区域取材。A组83%的患者和B组83%的患者经内镜标准确认宏观溃疡愈合。十二指肠溃疡愈合的突出组织学特征是PAS阳性上皮细胞显著增加。即使在宏观上完全愈合的情况下，十二指肠黏膜的超微结构改变在治疗结束时仍然存在。超微结构愈合过程呈现出与治疗类型无关的恒定模式。愈合中的十二指肠溃疡通过电子显微镜观察到的特征性形态学特征是出现胃窦型化生黏液分泌细胞。溃疡期遭到破坏的黏液结构在治疗4周后恢复正常的网状结构。
