一氧化氮在先天性肥厚性幽门狭窄肥厚肌和血中改变的研究

Study of Nitric Oxide in Pyloric Muscles and Blood in Infants with Congenital Hypertrophic Pyloric Stenosis

目的:测定一氧化氮(NO)在先天性肥厚性幽门狭窄(CHPS)肥厚肌中的改变,血中含量及术前术后的改变,探讨 CHPS 的发生和病理生理改变。方法:用还原性辅酶Ⅱ(NADPHd)组织化学染色法测定组织中一氧化氮合酶(NOS)含量;用比色法测定血中 NO 含量。21例 CHPS 术中取幽门肥厚之肌层;5例作幽门疾病取幽门肌层。结果:CHPS 组肥厚之环状肌层无 NADPHd(+)神经纤维染色,偶见扭曲、变形、染色浅的神经纤维。非幽门疾病组幽门环状肌、纵状肌、肌间神经元显示强 NADPHd(+)染色。血中 NO 含量 CHPS 组和非幽门疾病组之间差异无显著性(P=0.6);CHPS 组术前术后之间差异无显著性(P=0.5)。结论:CHPS 患儿肥厚之环状肌中NOS 缺如或明显减少,致幽门失松弛,幽门梗阻。血中 NO 含量因受多种因素影响,病理生理意义不完全明了,推测 CHPS 可能是定位于幽门的局限性疾病。

Objective:To search the changes of nitric oxide(NO)in hypertrophic pyloric mus- cles and blood of infants with congenital hypertrophic pyloric stenosis(CHPS).Methods:The dis- tribution of NO synthase(NOS)in the pyloric muscles was studied by nicotinamide adenine dinu- cleotide phosphate diaphorase(NADPHd)histochemical reaction.Twenty-one muscular specimens obtained from pyloromyotomy,and 5 specimens from infants without pyloric diease served as con- trol group.NO level in the blood of 9 cases with CHPS and the control(26 blood samples)was measured by chromometry.Results:NADPHd activity was absent in the fibers of the hypertro- phied pyloric circular muscles,and only a few nerve fibers in the longitudinal muscles and myen- teric plexus.Intense NADPHd was present in the nerve fibers of circular and longitudinal mus- cles,the neurons and myenteric plexus of control group.There was no difference of NO levels in the blood between the two groups(P=0.6),and no significant difference in the blood of CHPS group before and after operation(P=0.5).Conclusions:Lack of NOS in pyloric muscles may be responsible to the achalasia of pyloric sphincter and lead to pyloric obstruction while changes of NO levels in blood has no clinical significance.We infer that the pathological changes may be lo- calized in the circular pyloric muscles.