Comparison of histological features and inflammatory cell reaction in alcoholic, idiopathic and tropical chronic pancreatitis
Comparison of histological features and inflammatory cell reaction in alcoholic, idiopathic and tropical chronic pancreatitis
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DOI：
10.1002/bjs.4353
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发表时间：
2003-12-01
影响因子：
9.6
通讯作者：
Friess, H
中科院分区：
文献类型：
--
作者：
Shrikhande, SV;Martignoni, ME;Friess, H
背景：越来越多的证据表明，免疫机制可能在酒精性慢性胰腺炎的发生发展中起关键作用。然而，目前尚不清楚潜在病因学的差异是否会影响慢性胰腺炎患者的炎症反应。方法：对43例慢性胰腺炎患者(酒精性胰腺炎10例，特发性胰腺炎12例，热带慢性胰腺炎21例)的组织学特点和炎性细胞浸润模式进行研究。10名器官捐赠者作为对照。苏木精-伊红染色组织切片用于组织学评价。用四种抗体--CD_4、CD_8、CD_(45)和CD_(68)对炎症反应进行免疫组织化学表征。用计算机辅助图像分析对各种细胞浸润物进行定量评价。结果：热带地区慢性胰腺炎患者的静脉炎程度和血浆细胞总密度明显高于酒精性慢性胰腺炎患者。热带慢性胰腺炎的小叶内纤维化程度明显高于特发性。三组间特异性细胞浸润物(CD_4、CD_8、CD_(45)、CD_(68))差异无统计学意义。然而，酒精性胰腺炎的血管周围炎症评分显著高于特发性胰腺炎(P=0.037)，而特发性胰腺炎血管周围炎症面积评分明显低于酒精性胰腺炎(P=0.024)和热带胰腺炎(P=0.020)。结论：不同病因类型的慢性胰腺炎具有相似的组织学特征和相似的炎症细胞反应，表明慢性胰腺炎达到了共同的免疫学阶段，超过这个阶段，它似乎是一个单一的独特实体。
Background: There is increasing evidence that immune mechanisms may be crucial in the development of alcoholic chronic pancreatitis. However, it is not known whether differences in underlying aetiology influence the inflammatory reaction in patients with chronic pancreatitis. The histological features and the pattern of inflammatory cell infiltration were studied in three aetiological forms of chronic pancreatitis: alcoholic, idiopathic and tropical pancreatitis.Methods: Forty-three patients, ten with alcoholic, 12 with idiopathic and 21 with tropical chronic pancreatitis, were evaluated for the pattern of pancreatic inflammatory cell infiltration and histological features. Ten organ donors served as controls. Haematoxylin and eosin-stained tissue sections were used for histological evaluation. For immunohistochemical characterization of the inflammatory reaction, four antibodies - CD4, CD8, CD45 and CD68 - were used. Quantitative evaluation of the various cell infiltrates was performed with computer-assisted image analysis. The inflammatory cell infiltration pattern was also evaluated.Results: The degree of endophlebitis and the overall density of plasma cells were greater in tropical than in alcoholic chronic pancreatitis. The grade of intralobular fibrosis was significantly higher in tropical chronic pancreatitis compared with the idiopathic form. No significant quantitative differences in the specific cellular infiltrates (CD4, CD8, CD45, CD68) were observed in the three different groups. However, the perivascular inflammation number score was significantly higher in alcoholic compared with idiopathic pancreatitis (P = 0.037), and the perivascular inflammation area score was significantly lower in idiopathic than in alcoholic (P = 0.024) or tropical (P = 0.020) pancreatitis.Conclusion: Different aetiological forms of chronic pancreatitis result in similar histological features and a comparable inflammatory cell reaction, indicating that the disease, independent of the underlying aetiology, reaches a common immunological stage beyond which it appears to progress as a single distinctive entity.