Fry L, Seah P P, Harper P G, Hoffbrand A V, McMinn R M
J Clin Pathol. 1974 Oct;27(10):817-24. doi: 10.1136/jcp.27.10.817.
Small intestinal biopsies from 43 patients with dermatitis herpetiformis have been studied. The diagnosis of dermatitis herpetiformis was made on clinical and histological criteria and the presence of IgA deposits in the uninvolved skin. The macroscopic appearance of the intestinal biopsy was flat in 13, convoluted in 10, leaves only in eight, and fingers and leaves in 12. Twenty small intestinal biopsies from patients who did not have dermatitis herpetiformis or gastrointestinal disorder showed leaves only in three and fingers and leaves in 17. The mean total lymphocyte count per 1000 epithelial cells for this control group was 159 +/- SE 13; for the dermatitis herpetiformis patients with flat biopsies it was 464 +/- SE 27; for the convoluted biopsies 365 +/- SE 59; for leaves only 535 +/- SE 39; and for the fingers and leaves biopsies 301 +/- SE 31. The counts for all four groups are significantly greater than the control group (P < 0.001). Three of the 43 patients with dermatitis herpetiformis had lymphocyte counts below 200 per 1000 epithelial cells, and four of our controls had counts greater than 200 but none above 300. In the control group the mean counts for lymphocytes per 1000 epithelial cells in the basal position of the intestinal epithelium was 79 +/- SE 8; in the dermatitis herpetiformis flat biopsies it was 89 +/- SE 11; for the convoluted biopsies 93 +/- SE 12; for the leaves only biopsies 121 +/- SE 18 and for the fingers and leaves 98 +/- SE 13. However, the mean lymphocyte count in the perinuclear position was 81 +/- SE 7 for the controls, 362 +/- SE 23 for the flat dermatitis herpetiformis biopsies; 251 +/- SE 46 for the convoluted specimens; 402 +/- SE 43 for the leaves only specimens, and 195 +/- SE 25 for the fingers and leaves biopsies. The mean lymphocyte count for the supranuclear position was 0.55 +/- SE 0.22 for the control group; 13.7 +/- SE 2.3 for the flat dermatitis herpetiformis biopsies; 20.0 +/- SE 6.9 for the convoluted biopsies; 14.5 +/- SE 3.3 for the leaves only biopsies; and 8.3 +/- SE 2.6 for the fingers and leaves biopsies. Thus in gluten-sensitive enteropathy the increase in lymphocytes in the intestinal epithelium is in the perinuclear and supranuclear position. The ratio of basal lymphocytes to peri- and supranuclear lymphocytes appears to be 1:1 in normal intestinal epithelium, but approximately 1:4 in the gluten-sensitive enteropathy of dermatitis herpetiformis.
对43例疱疹样皮炎患者的小肠活检标本进行了研究。疱疹样皮炎的诊断依据临床和组织学标准以及未受累皮肤中IgA沉积物的存在情况。小肠活检标本的宏观表现为：13例扁平，10例卷曲，8例仅呈叶状，12例呈指状和叶状。20例无疱疹样皮炎或胃肠道疾病患者的小肠活检标本中，仅3例呈叶状，17例呈指状和叶状。该对照组每1000个上皮细胞的平均总淋巴细胞计数为159±标准误13；疱疹样皮炎患者活检标本扁平者为464±标准误27；卷曲者为365±标准误59；仅呈叶状者为535±标准误39；呈指状和叶状者为301±标准误31。所有四组的计数均显著高于对照组（P<0.001）。43例疱疹样皮炎患者中有3例每1000个上皮细胞的淋巴细胞计数低于200，我们的对照组中有4例计数大于200但无高于300者。对照组小肠上皮基底部位每1000个上皮细胞的淋巴细胞平均计数为79±标准误8；疱疹样皮炎患者活检标本扁平者为89±标准误11；卷曲者为93±标准误12；仅呈叶状者为121±标准误18；呈指状和叶状者为98±标准误13。然而，核周部位的淋巴细胞平均计数，对照组为81±标准误7，疱疹样皮炎患者活检标本扁平者为362±标准误23；卷曲标本为251±标准误46；仅呈叶状标本为402±标准误43；呈指状和叶状者为195±标准误25。核上部位的淋巴细胞平均计数，对照组为0.55±标准误0.22；疱疹样皮炎患者活检标本扁平者为13.7±标准误2.3；卷曲者为20.0±标准误6.9；仅呈叶状者为14.5±标准误3.3；呈指状和叶状者为8.3±标准误2.6。因此，在麸质敏感性肠病中，小肠上皮中淋巴细胞的增加位于核周和核上部位。正常小肠上皮中基底淋巴细胞与核周及核上淋巴细胞的比例似乎为1:1，但在疱疹样皮炎的麸质敏感性肠病中约为1:4。
