Halter S A, Greene H L, Helinek G
Hum Pathol. 1982 Sep;13(9):811-8. doi: 10.1016/s0046-8177(82)80077-4.
Small-intestinal biopsy specimens from five children with gluten-sensitive enteropathy (GSE) were studied by scanning electron microscopy (SEM) before dietary treatment and sequentially after removal of gluten from the the diet. Compared with biopsy specimens from patients without evidence of villous atrophy, these specimens showed marked architectural changes. In patients with total villous atrophy observed by light microscopy, absent villi and prominent crypts were observed by SEM. Patients with subtotal villous atrophy had the first stages of villous formation characterized by semicircular ridge formation. Biopsy specimens obtained from the five patients with GSE after dietary treatment demonstrated a sequence of changes characterizing villous repair. The earliest change consisted of semicircular elevations of cells around the crypts. Unequal cellular repletion around the crypts and migration of the cells led to the formation of parallel ridges. Increased cell proliferation resulted in thickening and twisting of the ridges to form convoluted ridges. Increased complexity of the ridges appears to lead to the formation of cerebriform ridges, and septation at various points in the ridges results in the formation of mitten-like villi. In biopsy specimens from patients with villous atrophy from other causes, similar reparative changes were seen by SEM. Scanning electron microscopy is a useful adjunct to the light microscopic and dissecting microscopic assessment of small intestine biopsy specimens, and may be more sensitive tan light microscopy in documenting early morphologic response to dietary treatment for gluten-sensitive enteropathy.
对5例麸质敏感性肠病（GSE）患儿的小肠活检标本在饮食治疗前及饮食中去除麸质后依次进行扫描电子显微镜（SEM）研究。与无绒毛萎缩证据患者的活检标本相比，这些标本显示出明显的结构变化。在光镜下观察到完全绒毛萎缩的患者中，SEM观察到绒毛缺失和隐窝突出。部分绒毛萎缩的患者具有以半圆形嵴形成为特征的绒毛形成的第一阶段。从5例GSE患者饮食治疗后获得的活检标本显示出一系列表征绒毛修复的变化。最早的变化包括隐窝周围细胞的半圆形隆起。隐窝周围细胞的不均衡充盈和细胞迁移导致平行嵴的形成。细胞增殖增加导致嵴增厚和扭曲形成盘绕的嵴。嵴的复杂性增加似乎导致脑回样嵴的形成，嵴上不同点的分隔导致手套样绒毛的形成。在其他原因导致绒毛萎缩患者的活检标本中，SEM观察到类似的修复变化。扫描电子显微镜是小肠活检标本光镜和解剖显微镜评估的有用辅助手段，在记录麸质敏感性肠病饮食治疗的早期形态学反应方面可能比光镜更敏感。
