贲门失弛缓症肠间质细胞及一氧化氮合成酶的免疫组化研究  

The role of nitric oxide（NO） and interstitial cell of Cajal（ICC） in the pathogenesis of achalasia

作　　者：李亮[1] 周平红[1] 姚礼庆[1] 徐美东[1] 陈巍峰[1] 蔡明琰[1] 胡健卫[1] 李全林[1] 刘靖正[1] 崔钊[1] 

机构地区：[1]复旦大学附属中山医院内镜中心、复旦大学附属中山医院外科学系,上海200032

出　　处：《中华消化内镜杂志》2014年第5期272-275,共4页Chinese Journal of Digestive Endoscopy

基　　金：上海市科委医学引导类计划项目（10411969600）

摘　　要：目的探讨贲门失弛缓（AC）与肠间质细胞（ICC）及一氧化氮（NO）之间的关系，以进一步研究AC的发病机理。方法选取2011年8月至2011年12月收治的贲门失弛缓症患者16例，经口内镜下肌切开术术中取活检组织作为实验组标本；选取非食管动力障碍性疾病手术患者15例，切取食管下括约肌作为对照组标本。采用免疫组化染色法，显微镜下随机选取3个视野观察ICC和由一氧化氮合酶在两组食管下括约肌中的分布和表达情况，计算肠间质细胞的个数和半定量判定一氧化氮合酶的表达强度。结果光镜下观察，对照组食管下括约肌中有肠间质细胞分布，呈梭形，两端细长突起，弥散分布在肌层中，与肌束平行走向，部分肠间质细胞间突起相互连接，每切片平均计数（11．2±7．4）个。实验组中肠间质细胞分布稀疏，细胞突起不明显，每切片平均计数（5．8±5．6）个，与对照组比较差异有统计学意义（P=0．01）。食管下括约肌中也可见一氧化氮合酶染色阳性神经纤维，对照组染色神经纤维粗大，染色深，实验组中神经纤维纤细，染色淡，分布稀疏，两组在染色强度上比较差异也有统计学意义（P=0．13）。结论肠间质细胞和一氧化氮合酶在贲门失弛缓症患者食管下括约肌中分布和表达异常，两者可能与贲门失弛缓症发病有关。Objective To investigate the correlationship between the nitric oxide（NO） and interstitial cell of Cajal（ICC） and achalasia （AC） and the pathogenesis of AC. Methods A total of 16 patients with AC who visited endoscopy center of the Zhongshan Hospital from August 2011 to December 2011were enrolled as the experimental group. The specimens of experimental group were obtained by biopsy of lower esophageal sphincter during peroral endoscopic myotomy（POEM） procedure. The 15 lower esophageal sphincter（LES） surgical specimens of non-esophageal motility disorders were enrolled as the control group. All specimens were made into paraffin sections and were examined by immunohistochemical staining method. The distribution of ICC and expression of nitric oxide synthase （NOS） under light microscope were observed. ICC was calculated and the staining intensity of NOS was semi-quantitatively evaluated in selected fields of vision at random. Results Under light microscope, ICC distributed and NOS was expressed in the LES. ICC was fusiform with two elongated apophysis. ICC was linked by apophysis and parallelly distributed with smooth muscle cells. The density of ICC in the experimental group was reduced and apophysis was less obvious com-pared with that in control group with significant differences （ 5.8 ± 5.6 VS 11.2 ± 7.4, P = 0. 01 ）. Likewise, NOS positive nerve fibers was visible in LES. NOS positive nerve fibers were absent and the strength of staining was weaker in AC group compared with that in control group with significant differences （P = 0. 13 ）. Conclusion Abnormal distribution of ICC and NOS in LES may be correlated with AC.

关 键 词：食管失弛症 肠间质细胞 一氧化氮合酶 

分 类 号：R571[医药卫生—消化系统]