Number and distribution of eosinophils and lymphocytes in the Japanese pediatric gastrointestinal tract: in search of a definition for "abnormally increased eosinophils"
Number and distribution of eosinophils and lymphocytes in the Japanese pediatric gastrointestinal tract: in search of a definition for "abnormally increased eosinophils"
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DOI：
10.1007/s12519-022-00646-x
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发表时间：
2022-11-27
影响因子：
8.7
通讯作者：
Ota, Hiroyoshi
中科院分区：
文献类型：
--
作者：
Iwaya, Mai;Kobayashi, Shota;Ota, Hiroyoshi
背景：原发性嗜酸性胃肠道疾病(EGID)构成慢性变态反应性炎症。嗜酸性粒细胞的数量是诊断标准之一；在日本，胃肠道(GI)中每高倍视野(HPF)超过20个嗜酸性粒细胞被认为是异常的。然而，被认为是正常的嗜酸性粒细胞的数量根据解剖位置和地理区域的不同而不同；这样的数值在日本儿科患者中没有报道，正常儿童胃中的淋巴细胞数量也没有报道。为了建立一个确定EGIDs诊断标准的参考，我们评估了正常的日本儿童胃肠道中的嗜酸性粒细胞的数量。方法对131例无明显临床病史、无内窥镜异常或无组织学异常的活检病例进行分析。采用免疫组织化学方法检测CD3、CD20的表达。结果盲肠嗜酸性粒细胞平均密度最高(49.5+/-22.4个/hpf)。在十二指肠[球部(20.0+/-9.6)和第二部分(30.0+/-15.8)]、末端回肠(38.3+/-22.7)、盲肠(49.5+/-22.4)、升结肠(42.3+/-25.3)、横结肠(29.4+/-17.0)和降结肠(32.2+/-17.9)中可观察到20个以上的嗜酸性粒细胞。在胃和直肠中，每个HPF的嗜酸性粒细胞计数少于10个；在食道中观察到每个HPF的嗜酸性粒细胞计数不到一个。在胃中观察到每个HPF有100多个CD3阳性T细胞。结论肠内嗜酸性粒细胞数平均大于20个/hpf。对于日本儿科，应该修订当前的嗜酸性粒细胞计数阈值。
Background Primary eosinophilic gastrointestinal disorders (EGIDs) constitute chronic allergic inflammation. The number of eosinophils is one of the diagnostic criteria; more than 20 eosinophils per high-power field (HPF) in the gastrointestinal (GI) tract are considered abnormal in Japan. However, the quantity of eosinophils considered normal varies according to anatomical location and geographical region; such values have not been reported in Japanese pediatric patients, nor have the numbers of lymphocytes in the normal pediatric stomach. To establish a reference for defining diagnostic criteria for EGIDs, we evaluated the number of eosinophils in the normal Japanese pediatric GI tract. Methods We examined 131 biopsy cases without significant clinical history, endoscopic abnormality, or histological abnormality. Immunohistochemical analysis of CD3 and CD20 was performed. Results The mean eosinophil density was highest in the cecum (49.5 +/- 22.4 per HPF). Counts of more than 20 eosinophils per HPF were observed in the duodenum [bulb (20.0 +/- 9.6) and second portion (30.0 +/- 15.8)], terminal ileum (38.3 +/- 22.7), cecum (49.5 +/- 22.4), ascending colon (42.3 +/- 25.3), transverse colon (29.4 +/- 17.0), and descending colon (32.2 +/- 17.9). Counts of fewer than 10 eosinophils per HPF were observed in the stomach and rectum; a count of fewer than one eosinophil per HPF was observed in the esophagus. More than 100 CD3-positive T cells per HPF were observed in the stomach. Conclusions The mean numbers of eosinophils in the bowel were greater than 20 per HPF. For Japanese pediatrics, the current threshold eosinophil count should be revised.