肠易激综合征患者内脏感觉及其与结肠黏膜肥大细胞、P物质和血管活性肠肽的相关性研究  

Correlation between rectal visceral perception and colonic mucous mast cells,substance P and vasoactive intestinal peptide in patients with irritable bowel syndrome

作　　者：杨娟 杨琦 张超 徐颢 李慧艳 李羽佳 Yang Juan;Yang Qi;Zhang Chao;Xu Hao;Li Huiyan;Li Yujia(Department of Digestive Medicine,Xi'an No.3Hospital,Xi'an 710000,China)

机构地区：[1]西安市第三医院消化内科,陕西西安710000 [2]西安市第三医院康复科,陕西西安710000

出　　处：《海军医学杂志》2018年第6期545-547,552,共4页Journal of Navy Medicine

摘　　要：目的研究肠易激综合征(irritable bowel syndrome,IBS)患者内脏感觉及其与结肠黏膜肥大细胞(colonic mucous mast cell,MC)、P物质(substance P,SP)以及血管活性肠肽(vasoactive intestinal peptide,VIP)的相关性研究。方法本研究对象为2017年7月至2018年2月于西安市第三医院治疗的30例IBS患者以及20例既往肠内镜下息肉切除术后复查者,分别设为观察组与对照组,留取升结肠、回肠末端、回盲部以及乙状结肠病理标本,采用应用特殊组织化学染色以及免疫组织化学染色检测比较不同部位黏膜MC密度以及VIP免疫反应阳性神经纤维指标;比较2组直肠对容量刺激的感觉变化。结果观察组升结肠、回肠末端、回盲部以及乙状结肠黏膜MC密度均高于对照组,差异具有统计学意义(P <0. 05);观察组各部位SP、VIP能神经纤维面积、强度平均值均高于对照组,差异均具有统计学意义(P <0. 05);观察组排便阀值、疼痛阀值、感觉阀值均显著低于对照组,差异均具有统计学意义(P <0. 05);观察组SP、VIP能神经纤维面积、强度平均值、MC密度与感觉阀值呈负相关(r=-0. 542、r=-0. 533、r=-0. 532、r=-0. 434,r=-0. 399,均P <0. 05)。结论 SP、VIP、MC可能参与到IBS的发生及发展,MC密度、SP、VIP能神经纤维的变化可能与内脏感觉高敏感性有关。Objective To investigate the correlation between rectal visceral perception and colonic mucous mast cells (MCs),substance P (SP),and vasoactive intestinal peptide (VIP)in patients with irritable bowel syndrome (IBS).Methods Thirty IBS patients who sought medical care from July,2017 to Feb,2018 and 20 patients who underwent endoscopic polypectomy and came to Xi'an No.3 Hospital for reexamination were enrolled as research subjects and were randomly assigned as the observation group and the control group.Pathological samples of ascending colon,terminal ileum,ilecocecal junction and sigmoid colon were collected for the study,histochemistry and immunohistochemistry were applied to compare indexes of MC density and VIP at different sites,and also to compare changes in the perception of rectal sensations of volume stimulation between the 2 groups.Results The MC density of ascending colon,terminal ileum,ilecocecal junction and sigmoid colon in the observation group was all significantly higher than that in the control group,with statistical significance (P <0.05).The mean area and intensity of SP and VIP nerve fibers in the observation group were significantly higher than those in the control group,and differences could be noted,when comparisons were made between the 2 groups (P <0.05).The defecation threshold,pain threshold,and sensory threshold of the observation group were all significantly lower than those of the control group,also with statistical significance (P <0.05).The sensory threshold in the observation group was nega-tively correlated with SP,VIP nerve fiber area,mean intensity and MC density (r =-0.542,r =-0.533,r =-0.532,r =-0.434, r =-0.399)(P <0.05).Conclusion SP,VIP,and MC might be involved in the occurrence and development of IBS,and changes in MC density,SP and VIP nerve fibers might be associated with the sensitivity of rectal visceral perception.

关 键 词：肠易激综合征 内脏感觉 MC P VIP 

分 类 号：R657.1[医药卫生—外科学]