Merrett M N, Soper N, Mortensen N, Jewell D P
Gastroenterology Unit, Radcliffe Infirmary, Oxford.
Gut. 1996 Aug;39(2):226-30. doi: 10.1136/gut.39.2.226.
Villous atrophy, mucin changes ('colonic metaplasia'), and chronic inflammation occur to varying degrees in all patients with ileal pouchanal anastomosis whereas acute inflammation (pouchitis) affects a subgroup of patients with prior ulcerative colitis.
To measure epithelial barrier function looking for possible functional adaptation in ileal 'pouch' mucosa.
Patients with an ileal pouch prior to ileostomy closure (n = 12), functioning pouch (n = 14), pouchitis (n = 8), and ulcerative colitis (n = 12) were assessed.
51Cr-EDTA was administered into the 'pouch' or rectum and urinary recovery over 24 hours was taken as an indication of permeability (barrier function). Histological analysis of 'pouch' biopsy specimens was undertaken.
Mucosal permeability is decreased from median 9.4% (range 5.4% to 39.1%) to 1.4% (range 0.38% to 2.2%) after ileostomy closure (p < 0.002) with levels being negatively correlated with two histological parameters of colonic metaplasia-mucin changes (p = 0.03) and villous atrophy (p = 0.05). Pouchitis was associated with increased permeability 5.9% (1.9% to 19.5%) compared with healthy 'pouch' 1.4% (0.35 to 2.2%) (p < 0.006).
Despite the presence of chronic inflammation in the mature 'pouch' functional adaptation with reduced permeability occurs in conjunction with colonic metaplasia.
在所有回肠贮袋肛管吻合术患者中，绒毛萎缩、黏蛋白改变（“结肠化生”）和慢性炎症会不同程度地出现，而急性炎症（贮袋炎）则影响一部分既往有溃疡性结肠炎的患者。
测量上皮屏障功能，寻找回肠“贮袋”黏膜可能的功能适应性变化。
评估了在回肠造口关闭前有回肠贮袋的患者（n = 12）、功能正常的贮袋患者（n = 14）、贮袋炎患者（n = 8）和溃疡性结肠炎患者（n = 12）。
将51Cr - 乙二胺四乙酸注入“贮袋”或直肠，以24小时尿液回收量作为通透性（屏障功能）的指标。对“贮袋”活检标本进行组织学分析。
回肠造口关闭后，黏膜通透性从中位数9.4%（范围5.4%至39.1%）降至1.4%（范围0.38%至2.2%）（p < 0.002），且水平与结肠化生的两个组织学参数——黏蛋白改变（p = 0.03）和绒毛萎缩（p = 0.05）呈负相关。与健康“贮袋”的1.4%（0.35%至2.2%）相比，贮袋炎与通透性增加至5.9%（1.9%至19.5%）相关（p < 0.006）。
尽管成熟“贮袋”存在慢性炎症，但随着结肠化生，仍会发生通透性降低的功能适应性变化。
