Chronic T cell-mediated enteropathy in rural west African children: Relationship with nutritional status and small bowel function
Chronic T cell-mediated enteropathy in rural west African children: Relationship with nutritional status and small bowel function
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DOI：
10.1203/01.pdr.0000076666.16021.5e
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发表时间：
2003-09-01
影响因子：
3.6
通讯作者：
Lunn, PG
中科院分区：
文献类型：
--
作者：
Campbell, DI;Murch, SH;Lunn, PG
冈比亚以前的研究表明，儿童生长不良对所有营养干预都有抵抗力，但最强烈的营养干预和高度依赖于与肠病有关的小肠通透性。因此，我们的目的是描述冈比亚农村儿童肠道通透性和营养状况相关的粘膜炎症反应。小肠活检取自38名冈比亚农村儿童（年龄，0.5-3岁），这些儿童具有一系列营养和临床状态（中位体重z评分，-4.6;范围，0.5至-6.4），其中75%患有腹泻。形态测定与免疫组化分析的一系列谱系和激活标志物，包括促炎和调节细胞因子，并与当前的临床状态和肠道通透性。与19名年龄匹配的英国人进行比较。对照所有冈比亚儿童，无论营养状况如何，都有慢性细胞介导的肠病伴隐窝增生、绒毛发育不良和大量上皮内淋巴细胞的证据。CD 25+细胞是英国的20倍。对照虽然小肠结构是独立的营养状况，T细胞数量上升，B细胞数量下降，营养恶化，粘膜细胞因子的生产变得偏向于促炎症反应，逐步减少转化生长因子-P的表达。热带肠病早于消瘦症的发作，其特征是细胞介导的T，I反应。蛋白质-能量营养不良与粘膜微环境中调节性免疫反应的减少有关，可能损害口服耐受的机制。
Previous studies from The Gambia have shown that poor childhood growth is resistant to all but the most intense nutritional intervention and highly dependent on small bowel permeability related to enteropathy. We thus aimed to characterize the mucosal inflammatory response in rural Gambian children in relation to intestinal permeability and nutritional status. Small bowel biopsies were taken from 38 rural Gambian children (age, 0.5-3 y) with a range of nutritional and clinical states (median weight z score, -4.6; range, 0.5 to -6.4), 75% of whom had diarrhea. Morphometry was performed with immunohistochemical analysis for a range of lineage and activation markers, including proinflammatory and regulatory cytokines, and related to current clinical status and gut permeability. Comparison was made with 19 age-matched U.K. controls. All Gambian children, regardless of nutritional status, had evidence of chronic cell-mediated enteropathy with crypt hyperplasia, villous stunting, and high numbers of intraepithelial lymphocytes. CD25+ cells were 20-fold higher than in U.K. controls. Although small bowel architecture was independent of nutritional status, T cell numbers rose and B cell numbers fell with worsening nutrition, and mucosal cytokine production became biased toward a proinflammatory response, with progressive decrease of transforming growth factor-P expression. Tropical enteropathy predates the onset of marasmus and is characterized by a cell-mediated T,I response. Protein-energy malnutrition is associated with reduction of regulatory immune responses in the mucosal microenvironment, potentially impairing the mechanisms of oral tolerance.