Luboinski J, Beaugerie L, Lamy P, Cosnes J, Gendre J P, Le Quintrec Y
Service d'Anatomie Pathologique, Hôpital Rothschild, Paris.
Gastroenterol Clin Biol. 1996;20(10):838-43.
The aim of the study was to test the hypothesis that some patients with functional diarrhea could actually suffer from a mild clinical pattern of collagenous or lymphocytic colitis.
Twenty consecutive patients with chronic diarrhea were included in the study if the colonic mucosa appeared normal during colonoscopy. From multiple colonic biopsies were established a conventional histological diagnosis and a quantitative histological diagnosis. This latter diagnosis was based on the semiquantitative evaluation of epithelial morphological alterations and lamina propria monocellular infiltration, and on the determination of both intraepithelial lymphocyte count and subepithelial collagen layer thickness. Multiple colonic biopsies from 12 control patients without diarrhea were analyzed according to the same protocol.
Among the 20 patients with diarrhea, the quantitative diagnosis of collagenous colitis was made in 3 patients (thickness of the collagen band between 11 and 26 microns) and the diagnosis of lymphocytic colitis in one (21% of intraepithelial lymphocytes). The percentage of intraepithelial lymphocytes did not differ between the 16 remaining patients and the controls (12 +/- 5% and 9 +/- 4%, respectively). Similarly, the score of surface epithelial damage and the score of lamina propria infiltration in patients with diarrhea (1.2 +/- 1.0 et 1.7 +/- 1.5) were not different from the values in the control group (1.3 +/- 1.3 et 1.5 +/- 1.2). The mean fecal weight in patients with diarrhea but without colitis was 161 +/- 130 g/d. All the values of fecal weight were below 300 g/d, except in one patient with a past history of truncular vagotomy.
These results suggest that most of the patients with functional diarrhea do not suffer from mild clinical patterns of collagenous or lymphocytic colitis.
本研究旨在验证以下假设，即部分功能性腹泻患者实际上可能患有轻度的胶原性或淋巴细胞性结肠炎临床症状。
若结肠镜检查时结肠黏膜外观正常，则将连续20例慢性腹泻患者纳入研究。通过多次结肠活检进行常规组织学诊断和定量组织学诊断。后者的诊断基于上皮形态改变和固有层单细胞浸润的半定量评估，以及上皮内淋巴细胞计数和上皮下胶原层厚度的测定。按照相同方案对12例无腹泻的对照患者的多次结肠活检进行分析。
在20例腹泻患者中，3例被诊断为胶原性结肠炎（胶原带厚度在11至26微米之间），1例被诊断为淋巴细胞性结肠炎（上皮内淋巴细胞占21%）。其余16例患者与对照组之间上皮内淋巴细胞百分比无差异（分别为12±5%和9±4%）。同样，腹泻患者的表面上皮损伤评分和固有层浸润评分（1.2±1.0和1.7±1.5）与对照组的值（1.3±1.3和1.5±1.2）无差异。无结肠炎的腹泻患者粪便平均重量为161±130克/天。除1例有迷走神经干切断术病史的患者外，所有粪便重量值均低于300克/天。
这些结果表明，大多数功能性腹泻患者并未患有轻度的胶原性或淋巴细胞性结肠炎临床症状。
