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Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis

发布日期:2018/4/6 23:54:46 文章来源: 作者: 点击次数:847

 

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Am J Surg Pathol, Volume 41, Number 11, November 2017

 

Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis

Brendan Boyle, MD, MPH,* Margaret H. Collins, MD,† Zhu Wang, PhD,‡ David Mack, MD,§ Anne Griffiths, MD, Cary Sauer, MD,¶ James Markowitz, MD,# Neal LeLeiko, MD,** David Keljo, MD,†† Joel Rosh, MD,‡‡ Susan S. Baker, MD,§§ Marian Pfefferkorn, MD,∥∥ Melvin Heyman, MD,¶¶ Ashish Patel, MD,## Robert Baldassano, MD,*** Joshua Noe, MD,††† Paul Rufo, MD,‡‡‡ Subra Kugathasan, MD,¶ Thomas Walters, MD, Lee Denson, MD,† Jeffrey Hyams, MD,‡ and on behalf of the PROTECT Study Group

From the *Nationwide Children’s Hospital, Columbus; †Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; ‡Connecticut Children’s Medical Center, Hartford, CT; §Children’s Hospital of Eastern Ontario, Ottawa; Hospital for Sick Children, Toronto, ON,Canada; ¶Emory Children’s Center, Atlanta, GA; #Cohen Children’s Medical Center, New Hyde Park; ‡‡Goryeb Children’s Hospital/Atlantic Health, Morristown; §§Women & Children’s Hospital of Buffalo WCHOB, Buffalo, NY; **Hasbro Children’s Hospital,Providence, RI; ††Children’s Hospital of Pittsburgh of UPMC,Pittsburgh, PA; ∥∥Riley Children’s Hospital Indiana University School of Medicine, Indianapolis, IN; ¶¶University of California, San Francisco, CA; ##UT Southwestern, Dallas, TX; ***Children’s Hospital of Philadelphia, Philadelphia, PA; †††Medical College of Wisconsin, Milwaukee, WI; and ‡‡‡Boston Children’s Hospital,Boston, MA.

Abstract: To characterize rectal histology in an inception cohort of children newly diagnosed with ulcerative colitis (UC) and to explore its relationship with clinical indices of disease severity. The PROTECT (Predicting Response to Standardized Pediatric Colitis Therapy) Study enrolled children 17 years of age and younger newly diagnosed with UC. Baseline rectal biopsies were evaluated for acute and chronic inflammation, eosinophilic inflammation (peak eosinophil count > 32 eosinophils/high powered field, eosinophilic cryptitis or abscesses), and architectural/nonarchitectural chronic changes. Correlation with clinical indices including Mayo endoscopy subscore and Pediatric Ulcerative Colitis Activity Index was performed. Rectal biopsies from 369 patients (mean age, 12.9±3.1 y, 50% female) were reviewed. Cryptitis was found in 89%, crypt abscesses in 25%, and eosinophilic inflammation in 58%. Crypt distortion/atrophy was present in 98% of specimens. Higher grades of acute and chronic inflammation were associated with the presence of basal plasmacytosis (P<0.0001), basal lymphoid aggregates (P<0.0001), and surface villiform changes (P<0.0001). A severe Mayo endoscopy subscore was most common among those with severe acute and chronic inflammation, although this relationship was not linear. Severe Pediatric Ulcerative Colitis Activity Index scores were associated with the absence of or only mild eosinophilic inflammation (<32  eosinophils/high powered field)(P<0.03) and the presence of surface villiform changes (P<0.005).Acute and chronic inflammation, eosinophilic inflammation and chronic changes are common in children newly diagnosed with UC.The clinical and biological implication of low to absent eosinophilic inflammation and the presence of surface villiform changes requires further study.

 

 

儿童新诊断的溃疡性结肠炎组织学与内镜严重程度的相关性

 

摘要:为了描述新近诊断的儿童溃疡性结肠炎(UC)的直肠组织学特征,并探讨其与疾病严重程度的临床指标的关系。PROTECT(标准化小儿结肠炎治疗的预测反应)研究招募了年龄在17岁以下、被新近诊断为UC的儿童,评估直肠活检基线针对急性和慢性炎症、嗜酸性炎(嗜酸性粒细胞计数>32个嗜酸性粒细胞/高倍视野,嗜酸性隐窝炎或脓肿)和结构性/非结构性的慢性改变。临床相关指标包括Mayo内镜评分和小儿溃疡性结肠炎活动指数。对369例患者(平均年龄12.9±3.1岁,女性50%)的直肠活检进行回顾性分析,89%病例发现有隐窝炎,25%有隐窝脓肿,嗜酸性炎58%98%的标本中存在隐窝畸形/萎缩。急性和慢性炎症的高评分与基底部出现浆细胞(P0.0001)、基底部淋巴细胞聚集(P0.0001)和表面绒毛状改变(P0.0001)相关。严重性急性和慢性炎症患者中,高Mayo内窥镜评分是最常见的,尽管这种关系不是线性的。重度小儿溃疡性结肠炎活动指数评分与嗜酸性粒细胞炎症(<32个嗜酸性粒细胞/高倍视野)(P0.03)和表面绒毛状改变(P0.005)无关或仅轻度相关。急性和慢性炎症、嗜酸性炎和慢性改变在新诊断为UC的儿童中是常见的。无或少量嗜酸性炎和表面绒毛状改变的这种临床和生物学意义还需要进一步的研究。(翻译 付欣)

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