CLASSIFICATION OF INTRACTABLE DIARRHEA IN INFANCY USING CLINICAL AND IMMUNOHISTOLOGICAL CRITERIA
CLASSIFICATION OF INTRACTABLE DIARRHEA IN INFANCY USING CLINICAL AND IMMUNOHISTOLOGICAL CRITERIA
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DOI：
10.1016/0016-5085(90)90624-a
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发表时间：
1990-10-01
期刊：
影响因子：
29.4
通讯作者：
CERFBENSUSSAN, N
中科院分区：
文献类型：
--
作者：
CUENOD, B;BROUSSE, N;CERFBENSUSSAN, N
一些实验研究表明，激活的肠T细胞可以诱导绒毛萎缩。这一观察结果使我们研究了激活T细胞在13例顽固性腹泻和不明原因绒毛萎缩儿童肠道病变发病机制中的可能作用。免疫组化研究显示7例患者肠道单核细胞活化。这些症状包括粘膜T细胞数量的显著增加，主要是TCR、α和β。+，固有层携带白细胞介素-2受体的细胞出现，肠细胞HLA-DR抗原表达增加。未发现肠道t细胞活化的局部原因。然而，7例患者中有4例有自身免疫的外源性症状，这表明肠道也可能是导致上皮病变的自身免疫反应的部位。在这些患者中，存在隐窝坏死和病变的绞痛延伸提示预后不良。相比之下，在其他6例患者中，没有获得粘膜t细胞活化的免疫组织化学证据。在后一种情况下，临床数据分析倾向于肠细胞分化的原发性先天性缺陷的假设。
Several experimental studies have demonstrated that activated intestinal T cells can induce villous atrophy. This observation led us to examine the possible role of activated T cells in the pathogenesis of intestinal lesions in a group of 13 children with intractable diarrhea and villous atrophy of unknown origin. Immunohistochemical study showed signs of intestinal mononuclear cell activation in seven patients. These signs included a marked increase in the number of mucosal T cells, mainly TCR .alpha..beta.+, the appearance of lamina propria interleukin-2-receptor-bearing cells, and an increased expression of HLA-DR antigens by enterocytes. No local cause of intestinal T-cell activation was found. However, four out of seven patients had extradigestive symptoms of autoimmunity, suggesting that the intestine might also be the site of an autoimmune reaction responsible for the epithelial lesions. In these patients, presence of crypt necrosis and colic extension of the lesions suggested poor prognosis. In contrast, in six other patients, no immunohistochemical evidence of mucosal T-cell activation was obtained. In the latter cases, analysis of clinical data favored the hypothesis of a primary inborn defect of enterocyte differentiation.