门静脉高压症大鼠胃粘膜形态学的实验研究  

Study on morphology of gastric mucosa in rats with portal hypertension

作　　者：周东风[1] 李兆亭[2] 靳明英[1] 乔庆荣[1] 代建华[1] 

机构地区：[1]济宁医学院附属医院肝胆外科,山东济宁272129 [2]山东医科大学附属医院普外科,山东济南250012

出　　处：《中国普通外科杂志》2000年第1期25-28,共4页China Journal of General Surgery

摘　　要：目的　探讨门静脉高压性胃病(PHG)的发病机理。方法　设计2组门静脉高压症动物模型,并与假手术组对照观察胃粘膜组织形态以及超微结构的病理变化,并通过微机图像处理系统对组织学图像进行定量分析。结果　门静脉高压时胃粘膜水肿明显,散在分布红点和/或瘀斑。光镜及扫描电镜检查均发现上皮细胞肿胀、崩解或脱落,腺体数目减少,粘膜变薄,无炎性细胞浸润和上皮细胞化生;粘膜下层水肿增厚。粘膜微血管结构的改变最具特征性。光镜见粘膜层毛细血管以及粘膜基底层和粘膜下层微静脉明显扩张。透射电镜则显示毛细血管变形,腔狭窄,细胞连接松散;内皮细胞内有大量的吞饮小泡;微静脉中膜内的平滑肌细胞、胶原纤维等细胞外基质增生。定量分析示门静脉高压大鼠微血管形态的改变表现为胃壁相对血管腔面积和相对血管壁面积显著高于假手术组;门静脉高压大鼠胃粘膜的损伤比与门静脉压力呈正相关,且肝硬化组明显大于门静脉狭窄组。结论　肝硬化门静脉高压症时伴有独特的胃部微血管形态学的异常,这种异常是PHG发生的病理学基础,是门静脉高压症病理变化的一部分。Objective To investigate the pathogenesis of portal hypertensive gastropathy(PHG). Methods Two rat models with portal hypertension(PHT) and a sham operation group were established to detect the pathological changes in histology and ultrastructure of the gastric mucosa as well as quantitative changes in histological morphology by graphic analysis computer system. Results Prominent edema, scattered red dots/ecchymosis were found in gastric mucosa in rats with PHT. Light and scan electron microscopy showed swelling or exfoliating of the epithelium cell, reduction of gastric gland number, thin of gastric mucosa, while infiltration of inflammatory cells, epithelium metaplasia were not found. The most characteristic findings were the changes of the mucosal capillaries and venules in both mucosal basal lamina and submucosa layer light microscopically, as well as the transmutation, stenosis and loose intercellular joining of the capillaries on electron microscopy. Ultrastructure observation revealed numerous pinocytes in epithelial cells as well as proliferation and hyperplasia of smooth muscle, collagenous fiber and extracellular matrix in venules. Quantitative analysis showed that the ratios of the cross sectional area and the vascular wall area between the gastric wall area(CSA/GWA & VWA/GWA) was higher in liver cirrhosis(LC) and portal vein stenosis(PVS) groups than that in sham operation(SO) group. There was a positive correlation between portal vein pressure and the ratio of the length of damaged mucosa and the length of mucosa(LDM/LM that was higher in LC group than in PVS group). Conclusions In rats with cirrhotic portal hypertension, distinct gastric microvascular morphological changes are the major etiological factor of PHG as a part of pathological changes in portal hypertension.

关 键 词：高血压 门静脉/病理学 胃粘膜/病理学 胃疾病/病理学 疾病模型 动物 

分 类 号：R657.340.2[医药卫生—外科学]