共聚焦激光显微内镜在体评估NSAIDs相关胃病及其药物干预效果  

Evaluation of NSAIDs-induced gastropathy and therapeutic effect by confocal laser endomicroscopy

作　　者：王晗[1] 石莎[1,2] 陈飞雪[1] 李月月[1] 曹静[1] 左秀丽[1] 李延青[1] 

机构地区：[1]山东大学齐鲁医院消化内科,山东济南250012 [2]聊城市人民医院消化内科,山东聊城252002

出　　处：《山东大学学报（医学版）》2014年第8期6-13,共8页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81170352;81270457)

摘　　要：目的应用共聚焦激光显微内镜(CLE)在体评价非甾体抗炎药(NSAIDs)相关胃病中黏膜屏障功能障碍,探索替普瑞酮和雷贝拉唑对急性胃黏膜损伤预防与治疗的作用机制。方法建立CLE急性胃黏膜损伤评分系统,在体评价NSAIDs相关急性胃黏膜损伤及药物干预效果,测定胃黏膜中occludin及ZO-1的表达水平。结果NSAIDs相关胃病模型组黏膜损伤评分明显高于正常组,ZO-1与occludin表达明显减少。而药物预防组与治疗组损伤评分均明显降低,紧密连接蛋白表达则明显增多。结论 CLE可以客观、实时、准确地评价NSAIDs相关胃黏膜损伤中黏膜上皮细胞损伤及黏膜通透性的改变。NSAIDs可以引起occludin和ZO-1表达减少,导致黏膜屏障功能障碍,替普瑞酮和雷贝拉唑可以通过抑制occludin和ZO-1的表达减少,从而改善黏膜屏障功能。Objective To explore the morphological nature and exact mechanisms of gastric mucosal barrier dysfunction underlying NSAIDs-related gastric damage by using confocal laser endomicroscopy（ CLE）,and to investigate how acute mucosal injuries are influenced by geranylgeranylacetone and rabeprazole. Methods After a 4-grade score system of acute gastric mucosal injury by CLE was established,and the severity of NSAIDs-induced gastropathy and effect of medication were evaluated. The expressions of occludin and ZO-1 were detected. Results The CLE score was significantly increased and expression of tight junctions was down-regulated after the administration of indomethacin. Geranylgeranylacetone and rabeprazole could intervene in the damage process and protect the integrity of the epithelial barrier. Conclusion CLE can be objective,real-time and accurate in assessing the severity of NSAIDs-induced gastropathy. Geranylgeranylacetone and rabeprazole can be used as efficient prophylactic and therapeutic medications in NSAIDs-related gastropathy for their protective effect in maintaining the integrity of gastric mucosal barrier.

关 键 词：共聚焦激光显微内镜 NSAIDs相关胃黏膜损伤 黏膜屏障功能障碍 替普瑞酮 雷贝拉唑 

分 类 号：R573.3[医药卫生—消化系统]