复杂性肛瘘内口病理特征和局部黏膜微生物群落特征的初探  

A preliminary study of the pathological characteristics of the internal orifice and the local mucosal microbial community in complex anal fistula

作　　者：朱静怡 张玲[2] 何笠 张俊 梅祖兵[2] 王振宜[1] 陈启仪 汪庆明[2] Zhu Jingyi;Zhang Ling;He Li;Zhang Jun;Mei Zubing;Wang Zhenyi;Chen Qiyi;Wang Qingming(Department of Anorectal Surgery,Yueyang Hospital of lntegrated Traditional Chinese and Western Medicine,Shanghai Universi-ty of Traditional Chinese Medicine,Shanghai 200437,China;Department of Anorectal Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shang-hai 201203,China;Department of Colorectal Disease,The Tenth People’s Hospital Affiliated to Tongji University,Shanghai 200724,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院肛肠科,上海200437 [2]上海中医药大学附属曙光医院肛肠科,上海201203 [3]同济大学附属第十人民医院结直肠病专科,上海200724

出　　处：《结直肠肛门外科》2023年第1期53-61,共9页Journal of Colorectal & Anal Surgery

基　　金：国家自然科学基金资助项目(81774112);上海市科委医学引导类(中、西医)科技支撑项目(19401933900)。

摘　　要：目的 观察复杂性肛瘘内口的组织学形态和黏蛋白2 (MUC2)表达情况。比较复杂性肛瘘患者内口黏膜组织与健康人群肛窦黏膜组织微生物群落组成与结构的差异。方法 (1)第一阶段:纳入2020年10月至2020年12月在上海中医药大学附属曙光医院肛肠科住院的40例复杂性肛瘘患者作为研究对象,术中留取肛瘘内口和瘘管组织及周边正常肠腺、肛窦和肛腺组织,显微镜下观察内口、瘘管、肛窦、肛腺和肛腺腺管的组织学形态。在显微镜下观察并比较肠腺与肛腺部位MUC2蛋白的表达情况。(2)第二阶段:纳入2022年2月至2022年3月复杂性肛瘘患者10例,并招募健康志愿者10例,分为肛瘘组和对照组,采集两组基线资料,并收集肛腺(或内口)处黏膜组织用于进行16s rDNA高通量测序及分析。结果 (1)第一阶段:肛瘘内口为肛腺感染形成,呈腺性结构。肛瘘瘘管周围可见大量炎症细胞和浆细胞浸润。肛腺开口于肛窦远心侧,表面含有少量杯状细胞和大量柱状上皮细胞(或复层扁平上皮细胞)。肛腺腺管周围可见少量炎症细胞浸润。肠腺MUC2蛋白的表达呈阳性,而正常肛腺呈弱阳性或阴性。(2)第二阶段:通过Alpha和Beta多样性分析发现两组物种组成具有明显组间差异。肛瘘组的均匀度明显低于对照组,而丰富度明显高于对照组(均P<0.05)。通过物种分类注释及差异分析发现两组具有明显差异(P<0.05),肛瘘组中变种梭杆菌的丰度显著高于对照组。且在两组丰度前10位的物种中,对照组中的琼氏不动杆菌明显高于肛瘘组(P=0.012)。通过KEGG数据库比对,两组在代谢通路预测方面同样存在显著差异,乙苯降解途径(Ethylbenzene degradation)、ECM受体相互作用途径(ECM-receptor interaction)和磷酸戊糖途径(Pentose phosphate pathway)主要富集于肛瘘组(均P<0.05),且肛瘘组中的磷酸戊糖途径(Pentose phosphate pathway)功能相对丰度明显高于对照�Objectives To observe the histological morphology and Mucoprotein 2(MUC2) expression in the internal orifice of complex anal fistula, as well as to compare the difference of the composition and structure of the microbial community in the mucosal tissue of the internal orifice of patients with complex anal fistula with the anal sinus mucosa of the healthy population.Methods(1) Part 1: Forty patients with complex anal fistula were included, who underwent surgery at the Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October to December 2020.During the operation, the tissues of internal orifice and fistula, surrounding normal intestinal gland, anal sinus, and anal gland were collected. The histological morphology of internal orifice, fistula, anal sinus, anal gland and anal gland tube was observed under a microscope. The expression of MUC2 protein in the intestinal gland and anal gland was observed and compared under a microscope.(2) Part 2: Ten patients with complex anal fistula and 10 healthy volunteers were recruited from February to March2022. They were divided into the anal fistula group and the control group. Baseline data were collected and mucosal tissue at the anal gland(or internal orifice) was collected for 16s rDNA high-throughput sequencing. Results(1) Part 1: The internal orifice of anal fistula is formed by anal gland infection, showing glandular structure. A large number of inflammatory cells and plasma cells were infiltrated around the fistula. The anal gland opened at the distal side of the anal sinus, and its surface contained a small number of goblet cells and a large number of columnar epithelial cells(or stratified flat epithelial cells). A small amount of inflammatory cells infiltration was observed around the anal gland tube. The expression of MUC2 protein was positive in intestinal gland, but weakly positive or negative in normal anal gland.(2) Part 2: Through Alpha and Beta diversity analyses, significant difference i

关 键 词：复杂性肛瘘 肠道菌群 黏蛋白2 

分 类 号：R657.16[医药卫生—外科学]