与T细胞克隆性分析相比,肠淋巴细胞的流式细胞术被认为是难治性乳糜泻中肠病相关T细胞淋巴瘤发展的更强预测因子。
研究难治性乳糜泻患者的临床特征与异常上皮内淋巴细胞之间的可能关联,并评估免疫表型鉴定高危难治性乳糜泻的准确性。
对对照组和乳糜泻患者的十二指肠活检组织中分离的淋巴细胞进行流式细胞术,并将结果与临床数据进行比较。
对42个对照进行流式细胞术分析,37例非复杂性乳糜泻和30例有或没有T细胞受体克隆性的难治性乳糜泻病例。上皮内淋巴细胞计数异常升高与严重吸收不良显着相关。15%的截止值(所有淋巴细胞中的异常淋巴细胞)具有识别高风险患者的最佳辨别能力。然而,这项技术未能识别一些高风险病例(敏感度63%,特异性100%)。吸收不良的严重程度被添加到高危难治性乳糜泻的标准中,改善正确的患者分配(灵敏度100%,特异性96%)。
异常上皮内淋巴细胞的免疫表型分型是高危难治性乳糜泻的良好预测指标。此外,在难治性乳糜泻的诊断评估中加入吸收不良的评估可以优化准确性.
Flow cytometry of intestinal lymphocytes is discussed to be a stronger predictor of enteropathy-associated T-cell lymphoma development in refractory celiac disease than T-cell clonality analysis.
To investigate possible associations between clinical characteristics of refractory celiac disease patients and
aberrant intraepithelial lymphocytes and to evaluate the accuracy of immunophenotyping for the identification of high-risk refractory celiac disease.
Flow cytometry of isolated lymphocytes from duodenal biopsies of controls and celiac disease patients was performed and results were compared to clinical data.
Flow cytometry analysis was performed on 42 controls, 37 non-complicated celiac disease and 30 refractory celiac disease cases with or without T-cell receptor clonality. Elevated
aberrant intraepithelial lymphocyte counts were significantly associated with severe malabsorption. A 15% cut-off (
aberrant lymphocytes among all lymphocytes) had the best discriminatory ability to identify high-risk patients. However, this technique failed to identify some high-risk cases (sensitivity 63%, specificity 100%). The severity of malabsorption was added to the criteria for high-risk refractory celiac disease, improving the correct patients\' allocation (sensitivity 100%, specificity 96%).
Immunophenotyping of
aberrant intraepithelial lymphocytes is a good predictor for high-risk refractory celiac disease. Furthermore, adding the evaluation of malabsorption to the diagnostic assessment of refractory celiac disease optimizes accuracy.