Campbell A P, Merrett M N, Kettlewell M, Mortensen N J, Jewell D P
Nuffield Department of Pathology and Bacteriology, John Radcliffe Hospital, Oxford.
J Clin Pathol. 1994 Sep;47(9):834-8. doi: 10.1136/jcp.47.9.834.
To investigate colonic metaplasia of goblet and columnar epithelial cells in ileal pouch mucosa; to correlate this with the degree of morphological and inflammatory change; and to assess whether such changes are related to the presence of faecal stasis.
Biopsy specimens of ileal pouch mucosa were taken from 31 patients (30 with ulcerative colitis, one with familial adenomatous polyposis) either before (eight patients) or after (23 patients) ileostomy closure. A simple morphological technique was used to assess changes in villous height. Inflammatory change was estimated using an established scoring system for pouchitis, and acquisition of colonic antigens was determined by immunohistochemistry using three monoclonal antibodies which recognise components of the two major epithelial cell types in the colorectum. The degree of staining with the monoclonal antibodies was graded and the grades correlated with an index of villous atrophy and with the inflammatory scores.
Five of eight (63%) pre-closure and 15 of 23 (65%) post-closure biopsy specimens showed increased staining with an antibody against components of columnar epithelial cells. One of eight (12%) pre-closure and 15 of 23 (65%) post-closure biopsy specimens stained with an antibody for colonic mucin. Although both types of staining showed a positive correlation with the pouchitis score, they also occurred in the absence of inflammation.
Both goblet and columnar cells acquire colonic characteristics which are incomplete, but may represent a true adaptive response as they can develop in the absence of inflammation. As the change in goblet cells occurs after ileostomy closure, faecal stasis is likely to be a major contributory factor. Changes in columnar cells may occur before ileostomy closure in the absence of faecal stasis.
研究回肠储袋黏膜中杯状细胞和柱状上皮细胞的结肠化生情况；将其与形态学和炎症变化程度相关联；并评估这些变化是否与粪便淤滞的存在有关。
从31例患者（30例溃疡性结肠炎患者，1例家族性腺瘤性息肉病患者）的回肠储袋黏膜中获取活检标本，其中8例在回肠造口关闭前取材，23例在回肠造口关闭后取材。采用一种简单的形态学技术评估绒毛高度的变化。使用既定的袋炎评分系统评估炎症变化，并通过免疫组织化学方法，使用三种识别结直肠两种主要上皮细胞类型成分的单克隆抗体来确定结肠抗原的获得情况。对单克隆抗体的染色程度进行分级，并将分级结果与绒毛萎缩指数和炎症评分相关联。
8例关闭前活检标本中有5例（63%）以及23例关闭后活检标本中有15例（65%）显示，抗柱状上皮细胞成分抗体的染色增加。8例关闭前活检标本中有1例（12%）以及23例关闭后活检标本中有15例（65%）对结肠黏蛋白抗体染色。尽管两种染色类型均与袋炎评分呈正相关，但它们也可在无炎症的情况下出现。
杯状细胞和柱状细胞均获得了不完全的结肠特征，但这可能代表一种真正的适应性反应，因为它们可在无炎症的情况下发展。由于杯状细胞的变化发生在回肠造口关闭后，粪便淤滞很可能是一个主要促成因素。柱状细胞的变化可能在回肠造口关闭前且无粪便淤滞的情况下发生。
