非糜烂性反流病食管黏膜超微结构研究

Ultrastructural investigation in esophageal mucosa of non-erosive gastroesophageal reflux disease

目的探讨非糜烂性反流病(NERD)病理性酸反流组及生理性酸反流组,其食管黏膜细胞间隙及桥粒数目等超微结构的变化情况。方法对10例健康志愿者(对照组)、39例NERD患者及10例反流性食管炎(RE)患者进行内镜检查并作食管黏膜活检,透射电镜观察标本。图像分析仪测量食管黏膜细胞间隙宽度,同时统计相应间隙中的桥粒数目。结果RE组及NERD组的细胞间隙宽度分别为(2.39±0.42)μm及(2.21±0.68)μm,两组间差异无统计学意义(P〉0.05)。对照组细胞间隙宽度为(0.63±0.21)μm,明显小于RE组及NERD组(P〈0.05)。NERD病理性酸反流组及生理性酸反流组的细胞间隙宽度分别为(2.45±0.67)μm及(1.91±0.67)μm,两组间差异有统计学意义(P〈0.05)。RE组及NERD组的桥粒数目均数分别为(0.124±0.044)个/μm2及(0.141±0.043)个/μm2,两组间差异无统计学意义(P〉0.05),但均少于对照组[(0.221±0.031)个/μm2],P〈0.05。NERD病理性酸反流组的桥粒数目[(0.110±0.032)个/μm2]明显少于生理性酸反流组[(0.171±0.028)个/μm2]。结论NERD组的细胞间隙明显宽于正常对照组,但与RE组无明显差别。NERD病理性酸反流组的细胞间隙明显宽于生理性酸反流组;细胞间隙间的桥粒数目也可能是酸诱导的细胞损伤标志。

Objective To explore the changes of uhrastructural characteristics including interstitial space dilation （ISD） and the number of desmosome in non-erosive gastroesophageal reflux disease （NERD） with abnormal and normal oesophageal acid exposure. Methods Nineteen patients with abnormal oesophageal acid exposure, 20 with normal oesophageal acid exposure, 10 with reflux esophagitis （RE） and 10 asymptomatic controls, classified on the basis of pH-metry, underwent endoscopy. Three biopsies were taken from the normal mucosa for light microscopy and transmission electron microscopy evaluation. ISD was measured and the number of desmosome in the intercellular spaces was calculated by using a digital scanner from photomicrographs of the specimens. The above two markers were compared with each other among the above groups. Results There was no significant difference in the mean score of the interstitial space between NERD and RE patients [ （2. 21 ± 0.68）μm versus （2.39±0.42）μm, P〉0.05）]. The mean score of the interstitial space of the control was （0.63 ±0.21）μm, much lower than those of NERD and RE patients （P〈0.01）. There was a significant difference in ISD between NERD with abnormal oesophageal acid exposure and normal oesophageal acid exposure [（2.45±0.67）0644m versus （1.91±0. 67）μm, P〈0.05]. The mean numbers of desmosome in the intercellular space of the NERD and RE patients were （0. 141 ± 0. 043） entries/μm^2 and （0. 124 ±0. 044） entries/μm^2, respectively, significantly lower than those of the controls [（0. 221 ±0.031） entries/μm^2. But no significant differences were observed between the RE and the NERD patients （P〉 0. 05）. Conclusions The interstitial space of esophageal mucosa in the NERD patients is dilated as in the RE. In NERD patients, the dilation of interstitial space is associated with abnormal acid exposure. The numbers of desmosome may also be a marker of esophageal mucosal injury of NERD.