CHRONIC DIARRHEA AND MALNUTRITION - HISTOLOGY OF THE SMALL INTESTINAL LESION
CHRONIC DIARRHEA AND MALNUTRITION - HISTOLOGY OF THE SMALL INTESTINAL LESION
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DOI：
10.1097/00005176-199102000-00010
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发表时间：
1991-02-01
影响因子：
2.9
通讯作者：
NEALE, G
中科院分区：
文献类型：
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作者：
SULLIVAN, PB;MARSH, MN;NEALE, G
本研究的目的是定量患有慢性腹泻营养不良综合征的冈比亚儿童的空肠病变。 共有 40 名受试者（20 名男性，20 名女性），平均年龄为 19.7 个月。 所有受试者均患有严重营养不良，其中 30 人患有消瘦症，9 人患有消瘦性恶性营养不良，1 人患有恶性营养不良。在接受测试的受试者中，70% 对纯化蛋白衍生物或念珠菌素的皮内攻击无反应。 通过计算机图像分析和免疫细胞化学对每位受试者入院后进行的空肠活检进行研究。 观察到一系列从“正常”到“平坦”的粘膜变化。 具有“正常”结构的粘膜显示小淋巴细胞浸润绒毛上皮，而隐窝肥大总是存在。 在另一个极端，平坦粘膜的表面上皮浸润较轻，尽管隐窝上皮内仍存在大量淋巴浸润。 免疫组织化学研究表明，大多数上皮内淋巴细胞属于CD8 + 表型。 粘膜形态与每个孩子的临床、生化或人体测量数据无关。 这些发现与细胞介导类型的某些环境抗原（饮食、微生物或两者）的肠道反应一致。 在缺乏肠道反应性自身抗体的情况下，隐窝上皮细胞上主要组织相容性类 2D 位点同种抗原的表达强化了这种解释。
The purpose of this study was to quantitate the jejunal lesion in Gambian children with chronic diarrhea-malnutrition syndrome. There were 40 subjects (20 male, 20 female) with a mean age of 19.7 months. All were severely malnourished, with marasmus in 30, marasmic kwashiorkor in 9, and kwashiorkor in 1. Of subjects tested, 70% were anergic to intradermal challenge with either purified protein derivative or candidin. Jejunal biopsies, performed on every subject after admission to hospital, were studied by computerised image analysis and immunocytochemistry. A spectrum of mucosal changes that varied from "normal" to "flat" was seen. Mucosae with "normal" architecture revealed infiltration of villous epithelium by small lymphocytes, while crypt hypertrophy was invariably present. At the other extreme, the surface epithelium of flat mucosae was less severely infiltrated, although heavy lymphoid infiltrates persisted within crypt epithelium. Immunohistochemical studies revealed that most intraepithelial lymphocytes were of the CD8 + phenotype. Mucosal morphology did not relate to clinical, biochemical, or anthropometric data for each child. These findings are consistent with an intestinal reaction to some environmental antigen (dietary, microbial, or both) of the cell-mediated type. This interpretation is strengthened by the expression of major histocompatability class 2D locus alloantigens on crypt epithelial cells in the absence of gut-reactive autoantibodies.