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Einfluß der Darmresektion auf das Verhalten der mononucleären Subpopulationen bei Morbus Crohn

Influence of bowel resection in Crohn's disease on the distribution of mononuclear subpopulations

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Summary

The literature data about the distribution of mononuclear cells in Crohn's disease are still contradictory. In 50 surgical C.D. patients, clinically classified corresponding to the Crohn's Disease Activity Index (CDAI), the T-lymphocytes and their subsets helper-T- and suppressor-T-lymphocytes (TH/TS) were therefore determined by use of monoclonal antisera, the B-lymphocytes by F(a b)-anti human Ig and the macrophages by uptake of latex microparticles. 37 C.D. patients underwent diseased bowel removal. Blood was drawn from the Crohn-draining mesenteric vein for analysis. Further investigations were performed at the 10th p. op. day as well as after an average period of 7 months (2–18). In comparison the mononuclear cell distribution was examined in 14 patients suffering from chronic osteitis and in 14 patients without any inflammatory disease as controls. C.D. patients showed preoperatively a significantly decreased TH/TS-ratio as well as a significantly increased proportion of macrophages. There was a lymphocytopenia in the peripheral differential blood count. Whereas the distribution of mononuclear subpopulations in the mesenteric blood was identical to the peripheral blood, significant lymphocytosis in the differential blood count of mesenteric blood was found. On the 10th p. op. day the TH/TS-ratio rose almost up to normal, which continued during the follow-up period. The macrophages remained constantly increased in all stages of investigation although during the follow-up none of the patients had signs of disease recurrence. Osteitis patients showed a similar distribution as C.D. patients, even if the changes compared to controls were not as distinct. The proportion of B-lymphocytes was the same in all groups examined. The individual TH/TS-ratios and proportions of macrophages of C.D. patients did not correlate to their clinical data. The changes within the T-cell-subpopulations seem to reflect less M. Crohn's disease itself than its inflammatory complications. Further studies have to be undertaken concerning the impact of the constant increase in macrophages, even after resection of the Crohn bearing bowel segment.

Zusammenfassung

Die Berichte über die Verteilung mononucleärer Zellen bei Morbus Crohn sind in der Literatur weiterhin widersprüchlich. Es wurden deshalb bei 50 chirurgischen M.C.-Patienten, welche klinisch nach dem Crohn's Disease Activity Index (CDAI) eingestuft wurden, die T-Lymphocyten und ihre Untergruppen T-Helfer und T-Suppressor-Lymphocyten (TH/Ts) mit monoklonalen Antiseren analysiert. Die B-Lymphocyten wurden durch ein F(a b)-anti-Human Ig und die Makrophagen durch Aufnahme von Latexmikropartikeln identifiziert. 37 M.C.-Patienten kamen zur Resektion des Crohn-befallenen Darmanteils. Dabei wurde auch Blut aus der Crohn-drainierenden Mesenterialvene zur Analyse gewonnen. Nachuntersuchungen erfolgten am 10. postop. Tag und nach durchschnittlich 7 Monaten (2–18). Zum Vergleich wurde die mononucleäre Zellverteilung bei 14 Patienten mit chronischer Osteitis, sowie bei 14 Patienten ohne entzündliche Erkrankungen als Kontrollkollektiv untersucht. Präoperativ zeigten die M.C.-Patienten einen signifikant erniedrigten TH/TS-Quotienten, sowie einen signifikant erhöhten Makrophagenanteil bei einer Lymphocytopenie im peripheren Differentialblutbild. Während die Verteilung der mononucleären Subpopulationen des mesenterialen Blutes im Vergleich mit dem peripheren Blut identisch war, fand sich im mesenterialen Differentialblutbild eine signifikante Lymphocytose. Bis zum 10. postop. Tag zeigte der TH/TS-Quotient eine weitgehende Normalisierung, der noch zum Zeitpunkt der Nachuntersuchung anhielt. Die Makrophagen waren zu allen Untersuchungszeiten konstant erhöht, obgleich alle Patienten zum Zeitpunkt der Nachuntersuchung klinisch keinen Anhalt für ein Crohn-Rezidiv zeigten. Die Osteitis-Patienten wiesen eine dem M.C. ähnliche, wenn auch nicht so stark vom Kontrollkollektiv abweichende Zellverteilung auf. Der B-Lymphocytenanteil war in allen untersuchten Kollektiven gleich. Für die individuellen TH/TS-Quotienten und Makrophagenanteile der M.C.-Patienten ließen sich keine Korrelationen zu klinischen Daten finden. Die Veränderungen innerhalb der T-Lymphocyten-Untergruppen scheinen weniger Ausdruck des Morbus Crohn selbst, als vielmehr seiner entzündlichen Komplikationen zu sein. Einer weiteren Klärung bedarf die Bedeutung der konstanten Makrophagenerhöhung, auch nach Resektion des Crohntragenden Darmsegmentes.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Abteilung 2.1.1 der Universität Heidelberg, Im Neuenheimer Feld 110, D-6900, Heidelberg

    R. Decker, M. Betzler, A. Scherer & H. P. Geisen

  2. Abteilung für Biostatistik des Tumorzentrums, Heidelberg - Mannheim

    U. Abel

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  1. R. Decker
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  2. M. Betzler
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  3. A. Scherer
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  4. U. Abel
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  5. H. P. Geisen
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Decker, R., Betzler, M., Scherer, A. et al. Einfluß der Darmresektion auf das Verhalten der mononucleären Subpopulationen bei Morbus Crohn. Langenbecks Arch Chiv 368, 173–183 (1986). https://doi.org/10.1007/BF01261234

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  • DOI: https://doi.org/10.1007/BF01261234

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