Jenkins D, Goodall A, Scott B B
Division of Pathology, Queen's Medical Centre, Nottingham, UK.
J Clin Pathol. 1997 Jul;50(7):580-5. doi: 10.1136/jcp.50.7.580.
To identify simple, objective, accurate histological criteria for distinguishing acute infective-type colitis, chronic idiopathic inflammatory bowel disease, and irritable bowel syndrome on rectal biopsy in patients with acute onset diarrhoea at first presentation, one to 10 weeks after onset.
Cell counts and measurements of mucosal architecture were made on initial rectal biopsies from 18 patients with acute infective-type colitis, 17 patients with first acute presentation of chronic idiopathic inflammatory bowel disease, and 23 patients with irritable bowel syndrome. The data were analysed by ANOVA and discriminant analysis.
Lamina propria cells were mainly in the upper third in irritable bowel syndrome patients. Increased lamina propria cellularity, mainly in the middle third, and numbers of crypt intraepithelial neutrophils distinguished acute infective-type colitis from irritable bowel syndrome in 93% of cases. Chronic idiopathic inflammatory bowel disease differed from irritable bowel syndrome and acute infective-type colitis in a decreased number of crypts and altered crypt architecture. Chronic idiopathic inflammatory bowel disease showed higher lamina propria cellularity, especially in the basal third, with an increased number of lamina propria neutrophils. On discriminant analysis, crypt numbers distinguished 86% of the cases of chronic idiopathic inflammatory bowel disease from the other groups.
At one week or more from onset, acute infective-type colitis is characterised by a superficial increase in lamina propria cellularity, with only a slight increase in the number of polymorphs. At this stage, chronic idiopathic inflammatory bowel disease is characterised by a transmucosal increase in cellularity together with crypt loss and architectural abnormality. Thus, measurement of mucosal architecture establishes simple, accurate, objective criteria for routine biopsy diagnosis of chronic idiopathic inflammatory bowel disease from acute infective-type colitis and irritable bowel syndrome at initial presentation, one to 10 weeks after onset.
确定在首次出现急性腹泻的患者发病1至10周后进行直肠活检时，用于区分急性感染型结肠炎、慢性特发性炎症性肠病和肠易激综合征的简单、客观、准确的组织学标准。
对18例急性感染型结肠炎患者、17例首次急性发作的慢性特发性炎症性肠病患者和23例肠易激综合征患者的初次直肠活检标本进行细胞计数和黏膜结构测量。数据采用方差分析和判别分析进行分析。
在肠易激综合征患者中，固有层细胞主要位于上三分之一处。固有层细胞增多（主要在中三分之一处）以及隐窝上皮内中性粒细胞数量增加，在93%的病例中可将急性感染型结肠炎与肠易激综合征区分开来。慢性特发性炎症性肠病与肠易激综合征和急性感染型结肠炎的不同之处在于隐窝数量减少和隐窝结构改变。慢性特发性炎症性肠病显示固有层细胞增多，尤其是在基底三分之一处，固有层中性粒细胞数量增加。在判别分析中，隐窝数量可将86%的慢性特发性炎症性肠病病例与其他组区分开来。
发病一周或更长时间后，急性感染型结肠炎的特征是固有层细胞表面增多，多形核细胞数量仅略有增加。在此阶段，慢性特发性炎症性肠病的特征是细胞穿过黏膜层增多，同时伴有隐窝缺失和结构异常。因此，对黏膜结构的测量为在发病1至10周后初次就诊时从急性感染型结肠炎和肠易激综合征中常规活检诊断慢性特发性炎症性肠病建立了简单、准确、客观的标准。
