Dilation of intercellular spaces is associated with laryngo-pharyngeal reflux: an ultrastructural morphometric analysis of laryngeal epithelium
Dilation of intercellular spaces is associated with laryngo-pharyngeal reflux: an ultrastructural morphometric analysis of laryngeal epithelium
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DOI：
10.1007/s00405-007-0295-z
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发表时间：
2007-08-01
影响因子：
2.6
通讯作者：
Gallo, Oreste
中科院分区：
文献类型：
--
作者：
Franchi, Alessandro;Brogelli, Beatrice;Gallo, Oreste
胃食管反流病（GERD）可能与耳、鼻和喉咙体征和症状相关，这种疾病通常被称为喉咽反流（LPR）。然而，喉黏膜的形态学改变与LPR目前知之甚少。由于鳞状上皮细胞之间的细胞间隙（DIS）的扩张被认为是胃食管反流病食管粘膜酸损伤的形态学标志，我们评估是否可以检测到类似的变化，在受LPR影响的患者的喉上皮。研究组包括15例受LPR影响的患者和7名正常对照，他们在杓间区进行了喉活检。常规处理标本进行光学显微镜和超微结构检查。使用计算机辅助形态测量系统在电子显微镜图像中测量细胞间隙。超微结构分析表明，不规则的细胞间隙扩张，从患者组的标本与LPR。另一个在少数患者中观察到的超微结构异常是存在大量胞浆空泡。计算机辅助形态学分析表明，LPR患者鳞状细胞之间的细胞间隙明显宽于对照组（411.7 nm +/- 188.6 SD vs. 155.8 nm +/- 56.4 SD，P = 0.003）。这些数据表明，DIS的上皮细胞的超微结构证据可能是酸反流的形态学标志物，已经在食管粘膜中描述。如果这一结果将在更大的系列中得到证实，它可能为识别LPR提供有用的诊断工具。
Gastroesophageal reflux disease (GERD) can be associated with ear, nose, and throat signs and symptoms, a condition often referred to as laryngopharyngeal reflux (LPR). However, the morphologic alterations of laryngeal mucosa associated with LPR are currently poorly understood. Since the dilation of intercellular spaces (DIS) between squamous epithelial cells is considered a morphologic marker of acid damage to esophageal mucosa in GERD, we evaluated whether similar changes can be detected in the laryngeal epithelium of patients affected by LPR. The study group included 15 patients affected by LPR and 7 normal controls, who underwent laryngeal biopsies at the interarytenoid area. Specimens were routinely processed for light microscopic and ultrastructural examination. The intercellular spaces were measured in electron microscopy images using a computer assisted morphometric system. Ultrastructural analysis demonstrated an irregular intercellular space dilation in specimens from the group of patients with LPR. Another ultrastructural abnormality observed in a minority of patients was the presence of numerous cytoplasmic vacuoles. Computer assisted morphometric analysis demonstrated that the intercellular space between squamous cells was significantly wider in patients with LPR than in control subjects (411.7 nm +/- 188.6 SD vs. 155.8 nm +/- 56.4 SD, P = 0.003). These data indicate that ultrastructural evidence of DIS of epithelial cells may be a morphologic marker of acid reflux, as already described in esophageal mucosa. If this result will be confirmed in larger series it may provide a useful diagnostic tool for the identification of LPR.