Ectors N L, Geboes K J, De Vos R M, Heidbuchel H P, Rutgeerts P J, Desmet V J, Vantrappen G R
Department of Pathology II, U.Z. St. Rafaël, Catholic University of Leuven, Belgium.
J Pathol. 1994 Jan;172(1):73-9. doi: 10.1002/path.1711720112.
At endoscopy, the duodenum in Whipple's disease frequently appears abnormal and some clinical features such as gastrointestinal blood loss and anaemia suggest epithelial damage. However, the intestinal epithelial cells themselves appear to be normal on light and electron microscopy. The aims of this study were to analyse in detail the cytological changes in epithelial cells over time and in response to therapy in biopsies obtained from 20 patients, to investigate the functional repercussion on digestive enzymes such as lactase, and to assess the expression by the epithelial cells of MHC antigens. Cytological changes were minimal at both the light- and the electron-microscopic level and MHC class I expression was preserved. However, changes indicative of functional deficits were demonstrated. Lactase and MHC class II expression were reduced or even absent. Antibiotic therapy resulted in normalization within 3-6 months. These findings are consistent with the clinical evolution and are of interest with regard to the importance of the immune response in aetiopathogenesis.
在内镜检查中，惠普尔病患者的十二指肠常表现异常，一些临床特征如胃肠道失血和贫血提示存在上皮损伤。然而，在光镜和电镜下，肠道上皮细胞本身似乎是正常的。本研究的目的是详细分析从20例患者获取的活检组织中上皮细胞随时间推移以及对治疗的细胞学变化，研究对乳糖酶等消化酶的功能影响，并评估上皮细胞对主要组织相容性复合体（MHC）抗原的表达。在光镜和电镜水平，细胞学变化均很微小，MHC I类分子表达得以保留。然而，显示出了功能缺陷的变化。乳糖酶和MHC II类分子表达降低甚至缺失。抗生素治疗在3 - 6个月内使各项指标恢复正常。这些发现与临床病程一致，且在免疫反应在病因发病机制中的重要性方面具有重要意义。
