Abstract
Lymphocytic esophagitis (LE) is an uncommon poorly defined histologic pattern. Its significance is largely unknown. The goal of our study was to characterize LE clinically, histologically, and immunophenotypically. Biopsies of 45 patients with LE and no intraepithelial granulocytes were selected throughout a 36-month period during routine diagnostic work. After reevaluation, complete absence of intraepithelial granulocytes was confirmed in 21 patients (LE-NG group), and few granulocytes were found in 24 patients (LE-FG). The control group consisted of 28 patients with active esophagitis consistent with reflux and overtly increased intraepithelial lymphocytes (REIL). The ratio of CD4:CD8 intraepithelial lymphocytes (IEL)>1 indicated predominance of CD4 IEL; the ratio ≤1 indicated predominance of CD8 IEL. Dysphagia was the primary complaint in 71%, 54%, and 39% of the patients with LE-NG, LE-FG, and REIL, respectively (P=0.04, LE-NG vs. REIL). Importantly, primary esophageal motility abnormalities were found in 10/11 (91%) tested LE-NG patients, 6/10 (60%) LE-FG patients, and 6/11 (54%) REIL patients. CD4 IELs were predominant in 81%, 50%, and 39% of LE-NG, LE-FG, and REIL cases, respectively (P=0.004, LE-NG vs. REIL), and in 90%, 83%, and 88% of the cases with primary motility abnormalities from the same groups. The prevalence of primary motility abnormalities was significantly higher in patients with CD4-predominant esophagitis than in patients with CD8-predominant esophagitis from all groups (21/24 [83%] vs. 2/8 [25%], P=0.005). A distinctive type of LE with predominance of CD4 IEL is associated with primary motility abnormalities suggesting a diagnostic utility of evaluating CD4 and CD8 subpopulations of T cells in LE.
摘要
淋巴细胞性食管炎是一种极不常见且尚无明确定义的组织学类型。它的意义大部分都未知。我们研究的目的是描述LE的临床特征、组织学表现和免疫表型。筛选36个月时间内活检病例,找出45例淋巴细胞性食管炎而无上皮内粒细胞的LE病人。再次评估后,上皮内粒细胞完全缺失的确认有21例(LE-NG)、上皮内有少量粒细胞的24例(LE-FG)。对照组为28例活跃的反流性食管炎伴明显上皮内淋巴细胞增加的病例(REIL)。上皮内淋巴细胞CD4:CD8比率>1表明是以CD4为主的上皮内淋巴细胞LE;CD4:CD8≤1则表明以CD8为主型的LE。吞咽困难是主要的不适症状 ,在LE-NG、LE-FG及REIL组中发生率分别是71%、54%、39%。(LE-NG与REIL组比较差异有统计学意义。P=0.04)重要的是,原发性食管蠕动异常在测试的LE-NG组中发生率为91%、LE-FG中为60%、REIL中为54%。CD4为主的上皮内淋巴细胞比率在上述三组中依次为81%、50%、39%。(LE-NG与REIL组比较差异有显著性。P=0.004)来自于同一组的原发性食管蠕动异常的 比率依次为90%、83%、88%。原发性食管蠕动异常的流行病学显示以CD4为主型的食管炎组要明显高于CD8的食管炎病人组。与原发性食管蠕动异常有关、以CD4为主的淋巴细胞性食管炎,提示评估淋巴细胞性食管炎中T细胞亚型CD4和CD8具有诊断价值。
共0条评论