肠易激综合征患者肠黏膜肥大细胞与神经纤维的关联  

Relationship between mast cells and nerve fibers in the intestinal mucosa in patients with irritable bowel syndrome

作　　者：王利华[1] 方秀才[1] 潘国宗[1] 

机构地区：[1]北京中国医学科学院中国协和医科大学北京协和医院消化内科,100730

出　　处：《中华消化杂志》2003年第6期332-335,共4页Chinese Journal of Digestion

摘　　要：目的　探讨肠黏膜肥大细胞与神经纤维之间的关联及其与肠易激综合征 (IBS)发病的关系。方法　应用电镜和免疫组化双重染色技术 ,对 5 6例符合罗马Ⅱ标准的腹泻型IBS患者和 12例非IBS对照组患者末端回肠和直肠 乙状结肠交界部位肠黏膜内的肥大细胞与神经纤维的关联进行了检测。结果　IBS患者和对照组肠黏膜内多数肥大细胞与神经纤维紧邻。患者末端回肠、直肠 乙状结肠交界处黏膜内神经元特异性烯醇化酶 (NSE)、P物质、5 羟色胺 (5 HT)的表达明显高于对照组 (P <0 .0 5 ) ,肥大细胞周围NSE、P物质、降钙素基因相关肽 (CGRP)、5 HT的表达也明显增强。IBS患者末端回肠黏膜内肥大细胞的数目 (10 .98± 2 .96 )与对照组 (6 .0 5± 0 .5 1)相比明显增多 (P <0 .0 1)。IBS患者与对照组相比 ,末端回肠内NSE(6 .73± 1.0 2比 4 .2 5± 0 .5 0 )、P物质 (6 .84± 0 .85比 4 .2 8± 0 .4 0 )、CGRP(6 .73± 0 .82比 4 .33± 0 .5 4 )、5 HT(6 .72± 0 .81比 4 .0 0± 0 .6 3)阳性神经纤维紧邻的肥大细胞数目亦明显增多 (P <0 .0 1)。结论　IBS患者肠黏膜内肥大细胞数量的增多及其周围神经肽表达的增强表明 :免疫系统与肠神经丛之间通路的活化可能与IBS的发病有关。Objective To elucidate the relationship of mast cells and intestinal nerves and the possible role of mast cells in the pathogenesis of irritable bowel syndrome (IBS). Methods In 56 patients with IBS who fulfilled the Rome Ⅱ criteria and in 12 non-IBS control subjects, biopsy specimens taken from the mucosae of terminal ileum and recto-sigmoid junction at colonoscopy were further examined using emission electron microscopy and double staining of mast cells with Alcian blue and immunohistochemical staining of the neuropeptide containing cells or nerve fibers with the monoclonal antibodies of the peptides. Results (1) As seen in electron microscopy, mast cells in the mucosa were distributed closely around the nerve endings.(2) In terminal ileum and distal colon of patients with IBS, the expression of mucosal neuron-specific enolase (NSE), SP(P-substance) and 5-serotonin(5-HT) were significantly higher than that of control group (P<0.05), and more intensive expressions of NSE, SP, calcitonin gene-related peptide (CGRP) and 5-HT were found around the mast cells. (3)The number of mast cells (mean±SE/per high power microscopy) in the mucosa with expressions of NSE(6.73±1.02 vs. 4.25±0.50), SP(6.84±0.85 vs. 4.28±0.40), CGRP(6.73±0.82 vs. 4.33±0.54) or 5-HT(6.72±0.81 vs. 4.00±0.63) positive nerve fibers in the surroundings increased significantly in terminal ileum in patients with IBS as compared with non-IBS controls (P<0.01).Conclusion An active pathway may exist between ENS and mast cells through certain mediators and neuropeptides. The mucosal immune response to an antigen, such as bacterial infection, will be transferred to the nervous system through this pathway and vise versa. Activation of the pathway may be part of the pathophysiological basis of IBS.

关 键 词：肠易激综合征 肠黏膜肥大细胞 肠神经丛 电镜 免疫组织化学 

分 类 号：R574[医药卫生—消化系统]