神经传导异常在先天性胆管囊肿发病机制中的作用  

Role of abnormal nerve conduction in the pathogenesis of congenital choledochal cyst

作　　者：徐伟立[1] 李索林[1] 李锦涛[1] 李英超[1] 于增文[1] 李萌[1] 周辉[1] 

机构地区：[1]河北医科大学第二医院小儿外科,石家庄050000

出　　处：《中华实验外科杂志》2014年第12期2849-2851,共3页Chinese Journal of Experimental Surgery

基　　金：河北省医学适用技术跟踪项目（GL201334）

摘　　要：目的 观察先天性胆管囊肿（CCC）肝外胆道中Cajal间质细胞和神经递质的表达,探讨神经传导异常在CCC发病中作用.方法 随机选取CCC患儿38例,男15例,女23例,所有患儿行囊肿切除、胆道重建术,分别切取CCC囊肿远、近端管壁和胆囊壁作为远端组、近端组和胆囊组.免疫荧光染色检测各组标本中Cajal间质细胞表达;逆转录-聚合酶链反应（RT-PCR）方法检测标本中乙酰胆碱和一氧化氮的合成关键酶——胆碱乙酰转移酶（CHAT）和神经元型一氧化氮合酶（nNOS）表达,所有数据应用SPSS 13.0软件进行统计分析.结果 Cajal间质细胞在囊肿远端与近端、囊肿远端与胆囊表达比较差异有统计学意义（P＜0.01）,而在囊肿近端与胆囊间差异无统计学意义（P＞0.05）.CHAT在近端组（1.39±0.11）、胆囊组（1.32±0.14）表达均少于远端组（1.78±0.21）（P＜0.01）;近端组和胆囊组之间差异无统计学意义（P＞0.05）.nNOS在近端组（1.64±0.16）、胆囊组（1.60±0.13）表达均多于远端组（1.14±0.11）（P＜0.05）;近端组和胆囊组之间差异无统计学意义（P＞0.05）.CHAT和nNOS在Ⅰ型CCC远端（1.95 ±0.27、1.14 ±0.12）和Ⅳ型CCC远端（1.81 ±0.08、1.11 ±0.13）表达差异均无统计学意义（P＞0.05）;而在Ⅰ型CCC近端（1.04±0.17、1.95 ±0.24）和Ⅳ型CCC近端（1.39 ±0.13、1.70 ±0.20）表达差异均有统计学意义（P＜0.05）.结论 CCC肝外胆道不同部位Cajal间质细胞及其调控的兴奋性和抑制性神经递质的表达差异是导致CCC形成的原因之一;两种递质的表达分布异常可能造成不同类型的CCC发病.Objective To observe the expression levels of interstitial cells of Cajal （ICCs） and neurotransmitters in the extrahepatic biliary of congenital choledochal cysts （CCC）,and to explore the role of abnormal nerve conduction in the pathogenesis of CCC.Methods A total of 38 child patients with CCC,15 males and 23 females,were randomly enrolled in this study and underwent cyst excision and biliary revascularization.The specimens were obtained from the distal cyst wall,the proximal cyst wall and gallbladder wall respectively and were classified into the corresponding groups.The expression of ICC was detected by immunotluorescence analysis and that of choline acetyltransferas （CHAT） and neuronal nitric oxide synthase （nNOS）,the key enzymes for synthesis of acetylcholine and nitric oxide respectively,was analyzed by real-time polymerase chain reaction （RT-PCR）.All of data were analyzed by SPSS 13.0 software for Windows.Results There was significant difference in the expression of ICCs between the distal cyst wall and the proximal cyst wall,also between the distal cyst wall and gallbladder wall （P 〈 0.01）.However,there was no significant difference between the the proximal cyst and gallbladder （P 〉 0.05）.The expression level of CHAT in the proximal cyst wall （1.39 ±0.11） and gallbladder wall （1.32 ±0.14） was significantly lower than in the distal cyst wall （1.78 ±0.21,P 〈0.05）,but no significant difference existed between the proximal cyst wall and gallbladder wall （P 〉 0.05）.The expression level of nNOS in the proximal cyst wall （1.64 ±0.16） and gallbladder wall （1.60 ±0.13） was higher than in the distal cyst wall （1.14±0.11,P 〈 0.05）,but no significant difference existed between the proximal cyst and gallbladder （P 〉 0.05）.There was no significant difference in the expression levels of CHAT and nNOS in the the distal cyst wall between type Ⅰ CCC （1.95 ±0.27,and 1.14 ±0.12） and type ⅣW CCC （1.81 ±0.08 and 1.11 ± 0.13,P 〉0.05）.

关 键 词：胆管囊肿 先天性 肠神经 CAJAL间质细胞 神经递质 胆碱乙酰转移酶 一氧化氮合酶 

分 类 号：R726.5[医药卫生—儿科]