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Virchows Archiv A

, Volume 352, Issue 3, pp 226–245 | Cite as

Vergleichende Untersuchungen zur Morphologie der Dünndarmschleimhaut bei verschiedenen Formen des Malabsorptionssyndroms sowie bei anderen Erkrankungen im Kindesalter

  • A. Vogel
Article

Zusammenfassung

Die Ergebnisse intestinaler Saugbiopsien bei 54 Kindern mit verschiedenen Formen des Malabsorptionssyndroms sowie mit anderen Erkrankungen werden vergleichend ausgewertet. Dabei werden Länge von Krypten und Zotten, Mitoserate, Anzahl der Panethschen Körnerzellen und Relationen der freien Zellen in der Lamina propria berücksichtigt.

Für die Kontrollen errechnet sich der Mittelwert der durchschnittlichen Zottenlänge mit 393 µ, der Mittelwert der durchschnittlichen Kryptenlänge mit 179 µ, der Mittelwert des Zotten-Krypten-Index mit 2.298.

Der Zotten-Krypten-Index erweist sich als ein Kriterium, das für die Beurteilung der bioptisch gewonnen Dünndarmschleimhaut besonders aussagefähig ist. Anhand des Vergleichs der erhaltenen Meßwerte mit den auflichtmikroskopischen Befunden werden Richtlinien für eine Klassifizierung der nachgewiesenen Schleimhautveränderungen herausgearbeitet. Bei den Kontrollen liegen über 50% der Zotten-Krypten-Raten in einem Bereich von 1,6-3,5. Bei der partiellen Atrophie sind über 70%, bei der subtotalen Atrophie über 90% der Zotten-Krypten-Raten kleiner als 0,6.

Für die Panethschen Körnerzellen sowie für den Mitoseindex werden bei den einzelnen Krankheitsgruppen keine signifikanten Unterschiede zu den Kontrollgruppen festgestellt.

Die erstmalig durchgeführte qualitative Analyse der freien Zellen in der Lamina propria vermittelt einen Einblick in die immunologische Aktivität der Darmschleimhaut. Eine Verschiebung der Zellrelationen zugunsten von Plasmazellen kann einer gesteigerten immunologischen Aktivität entsprechen. Sie wird außer bei der Coeliakie nur bei Hepatitis epidemica gefunden.

Morphological investigatious on intestinal mucosa in various forms of malabsorption syndrome and in other diseases in childhood

Summary

Intestinal biopsies from 54 children with different forms of malabsorption syndrome and with other diseases were evaluated histologically. Criteria for evaluation were: the length of crypts and villi, the index of mitosis, the quantity of Paneth cells and the type of cells in the lamina propria.

Among the controls, the arithmetic mean of the average length of villi is 393 µ, of the average length of crypts is 179 µ, of the villus-crypt-ratio is 2.298.

The villus-crypt-ratio is of particular importance. By comparing results of the histological measurements of the mucous membrane with the surface structure as seen under the dissecting microscope we could find criteria for classifying the pathologic alterations. Among the controls, 50% of the villus-crypt-ratios were between 1.6 and 3.5. In partial atrophy, more than 70% and in subtotal atrophy, more than 90% of the villus-crypt-ratios were below 0.6.

The quantity of Paneth cells and the index of mitosis were not significantly altered in various diseases.

As regards the different cell types in the lamina propria, a relative increase of plasma cells was found only in celiac disease and in viral hepatitis, it may correspond to an increased immunologic activity of the intestinal mucosa.

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© Springer-Verlag 1971

Authors and Affiliations

  • A. Vogel
    • 1
    • 2
  1. 1.Universitäts-Kinderklinik WürzburgGermany
  2. 2.Institut für PathologieKlinikum Steglitz der Freien Universität BerlinBerlin 45Deutschland

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