组织细胞在炎性肠病鉴别诊断中的意义

 目的 研究炎性肠病(inflammatory bowel disease,IBD)肠黏膜内组织细胞种类与分布特点,为其鉴别诊断寻找线索。方法 参照2012年中华医学会新制定的诊断标准选取病例,结合临床病史及内镜下表现做出诊断,确定溃疡性结肠炎(ulcerative colitis,UC)组 30例,克罗恩病(Crohn’s disease,CD)组 26例,选取10例正常肠黏膜作为对照组。所有病例均HE染色及加做6项免疫组化染色(CD1a、CD21、CD68、CD163、S-100、Ki-67)。所有切片均扫描进入优纳ISCAN系统进行半定量分析。结果 UC(80.72±17.15)个/10⁴ μm²及CD(78.59±16.37)个/10⁴ μm²的固有层内细胞数与正常对照组(59.57±14.04)个/10⁴ μm²相比均具有显著的统计学意义(P<0.01)。CD1a在正常肠黏膜及UC内几乎没有表达[(0.72±0.79)个/10⁴ μm², CD(22.19±10.19)个/10⁴ μm²]统计分析比较与正常对照组及UC(1.32±2.26)个/10⁴ μm²均有统计学意义(P<0.05)。CD21在组织学上的鉴别诊断意义不大。S-100三组的组间比较均具有统计学意义(P<0.05)。CD68 CD组(16.02±7.33)个/10⁴ μm²的阳性细胞数少于正常对照组(21.92±6.18)个/10⁴ μm²和UC组(19.96±11.31)个/10⁴ μm²,与UC及正常对照组比较均具有统计学意义(P<0.05)。CD163染色时CD与UC组比较无统计学意义。 Ki67三组的组间比较均具有统计学意义(P<0.05)。结论 通过多种组织细胞免疫组化染色结果可以综合判断IBD的免疫状态及对UC和CD进行鉴别诊断。

Significance of tissue cells in diagnosis of inflammatory bowel disease

Objective Inflammatory bowel disease(IBD) includes ulcerative colitis(UC) and Crohn’s disease(CD). Definitive diagnosis of UC and CD relies on colonoscopy and biopsy, but it is difficult to give a definitive diagnosis for pathologists by specimens taken from colonoscopy. We hope that through the study for distribution and types of tissue cells within lesions ,looking for new clues to differential diagnosis.Methods Combining clinical history, endoscopy and the new standard, we remade the diagnosis, finally made sure of 30 cases of UC, 26 cases of CD, and 10 cases of normal intestine mucosa taken as the control. All the cases were re-stained by HE and two-step IHC for 6 items of antigens(CD1a、CD21、CD68、CD163、S-100、Ki-67), and these sections were analyzed by UNISCAN system to do semi-quota standard. The SPSS13.0 was used for statistics. The IHC was also analyzed through dividing the strength of the positive staining. Results The cell number in the CD and UC was significantly different from the control(P<0.01). In the CD mucosa, there were more positive cells than in the normal control and UC, with statistically significant difference(P<0.05).The CD21 expression could be the result of other cells stained, and had little diagnostic value. The S-100 positive cell types were rich in these 3 groups, in every two group with statistically significant difference(P<0.05).There was no CD68 expression statistically significant difference in the UC group compared with normal control(P>0.05), but the positive cell number in the CD group were less compared with the normal control and UC group, with statistically significant difference(P<0.05). There were rare Ki67 positive cells in the control group. In the UC group the Ki67 positive cells were more than in the CD group. Three groups of comparisons between groups were statistically significantly different (P<0.05).Conclusions These antibodies can be used as staining differential diagnosis of UC and CD. CD1a:UC(-),CD(+); Ki67 UC(+>10%),CD(+1%-2%);number of positive cells of S-100 and CD68, UC〉CD. The other antibodies can be used as auxiliary diagnositic means.