Sankey E A, Dhillon A P, Anthony A, Wakefield A J, Sim R, More L, Hudson M, Sawyerr A M, Pounder R E
University Department of Histopathology, Royal Free Hospital School of Medicine, London.
Gut. 1993 Mar;34(3):375-81. doi: 10.1136/gut.34.3.375.
Aphthoid ulceration has been regarded as an early macroscopic feature of Crohn's disease, yet the cause of this mucosal lesion is unknown. Examination of areas of apparently normal and non-inflamed bowel in Crohn's disease has allowed the identification of mucosal changes which occur before macroscopic and microscopic ulceration. Thirty five resection specimens from patients with Crohn's disease were compared with 12 specimens from patients with ulcerative colitis and 13 controls. Specimens were fixed either by immersion in formalin in the routine way or by perfusion fixation with formalin at mean arterial pressure. Immunostaining for macrophages, vessel wall, and blood constituents allowed identification of small mucosal capillaries which were not apparent otherwise. In Crohn's disease damage and rupture of these small capillaries occurred before infiltration of the lamina propria by inflammatory cells. Loss of the overlying epithelium seemed to follow this vascular damage.
口疮样溃疡一直被视为克罗恩病的早期宏观特征，然而这种黏膜病变的病因尚不清楚。对克罗恩病患者看似正常且未发炎的肠段进行检查，已能识别出在宏观和微观溃疡出现之前发生的黏膜变化。将35例克罗恩病患者的切除标本与12例溃疡性结肠炎患者的标本及13例对照标本进行比较。标本要么按常规方法浸入福尔马林固定，要么在平均动脉压下用福尔马林灌注固定。对巨噬细胞、血管壁和血液成分进行免疫染色，得以识别出原本不明显的小黏膜毛细血管。在克罗恩病中，这些小毛细血管的损伤和破裂发生在固有层被炎性细胞浸润之前。上皮的缺失似乎继发于这种血管损伤。
