慢传输型便秘结肠神经病理改变的意义  

Pathological changes and clinical significance of colonic myenteric plexus in patients with slow transit constipation

作　　者：田波[1] 杨世玲[1] 李云华[1] 段全红[1] 陈国庭[1] 厉峰 马善符[1] 

机构地区：[1]潍坊医学院附属医院肛肠外科,山东省潍坊市261031

出　　处：《世界华人消化杂志》2000年第12期1385-1388,共4页World Chinese Journal of Digestology

摘　　要：目的研究慢传输型便秘结肠肌间神经丛的神经丝蛋白和 S-100蛋白的病理改变,探索结肠动力减弱的原因,为临床治疗提供理论依据.方法采用免疫组织化学方法研究33例结肠慢传输型便秘患者(STC 组)和25例非便秘性结肠(对照组)的升结肠、横结肠、降结肠、乙状结肠的肌间神经丛内神经丝蛋白和 S-100蛋白的表达,利用计算机图象分析系统作定量分析,并与病程及年龄作直线相关性分析.所得数据用 t 检验进行统计学处理.结果对照组结肠肌间神经丛内神经丝蛋白和 S-100蛋白的含量在各段之间无显著性差别(0.09±0.03 vs 0.10±0.02,P>0.05),STC 组结肠各段与对照组比较,神经丝蛋白的平均光密度值明显高于对照组(0.12±0.03 vs 0.09±0.02,P<0.01);S-100蛋白的含量及平均光密度值明显高于对照组(0.10±0.04 vs 0.08±0.03,P<0.01).神经丝蛋白和 S-100蛋白的改变随着病程的延长而增加,二者呈直线相关(r=0.75)结论慢传输型便秘结肠肌间神经丛存在着全结肠性退行性病理改变,表现为神经丝蛋白的堆积聚集和神经间质的增生,且随着病程的延长而加重,这是造成结肠动力减弱的主要原因.提示,手术切除结肠的范围应是全结肠或次全结肠.AIM To investigate the pathologic features of the neurofilaments(NF)and S-100 protein in the colonic myenteric plexus in patients with slow transit constipation (STC)and to explore the reason of the weakened colonic motility,and to provide theoretical basic for clinical therapy. METHODS By using quantitative immunohistochemistry with computer-assisted image analysis system,we investigated the expression of the NF and S-100 protein in the myenteric plexus of the ascending,transverse, descending and sigmoid colon from 33 patients with STC and 25 non-constipated patients(the controls), RESULTS The contents of the NF and S-100 protein had no significant difference in each part of colon in the controls(0.09±0.03 vs 0.10±0.02 P>0.05).Compared with the controls,the NF in the STC group appeared accumulated locally and stained densely,the mean optical density(A)of the NF was significanty higher than the controls(0.12±0.03 vs 0.09±0.02 P<0.01).The content and A of S-100 protein were also higher than the controls(0.10±0.04 vs 0.08±0.03 P<0.01),and it was increased with the extension of the disease,the two amounts were linearly related(r=0.75). CONCLUSION There were pathologic features in the myenteric plexus in total colon of the STC patients with local accumulation and dense staining of the NF.And it progressed with the disease course which is the reason for the lowered motility.The scope of colectomy would be total or subtotal.

关 键 词：便秘 结肠 神经支配 神经丝蛋白 免疫组织化学 

分 类 号：R574.62[医药卫生—消化系统]