肝硬化患者十二指肠黏膜超微结构的改变及其意义

Ultrastructural changes of duodenal mucosas and their significance in patients with liver cirrhosis

目的观察肝硬化患者十二指肠黏膜超微结构的改变,探讨其意义。方法按常规内镜下活检术获取研究对象的十二指肠黏膜并行透射电镜检查,观察其超微结构;分别检测血浆内毒素,血氨、PT、Alb和TBil水平,分析十二指肠黏膜超微结构改变与上述指标变化之间的关系。结果60例肝硬化患者中31例出现十二指肠黏膜超微结构改变,发生率为52%,表现为黏膜上皮细胞微绒毛减少、变短,胞核固缩;肠黏膜上皮细胞紧密连接间隙增宽以及线粒体肿胀等。其发生率以Child-Pugh A级组最低（25%）,B级组次之（45%）,C级组最高（85%）（P＜0．01）。伴有十二指肠黏膜超微结构改变的肝硬化患者,其血浆内毒素、血氨、TBil明显升高,PT延长,Alb水平明显降低（P＜0．01）。结论肝硬化患者存在十二指肠黏膜超微结构改变,其发生率随肝硬化病情的加重而增高;小肠黏膜超微结构改变在肝硬化患者内毒素血症、血氨升高等异常中可能具有重要意义。

Objective To investigate the ultrastructural changes of duodenal mucosas and their significance in patients with liver cirrhosis （PLC）. Methods Endoscopic biopsy duodenal mucosa specimens of 60 PLC and 18 healthy volunteers as controls were obtained. Ultrastructural changes of them were studied with transmission electron microscopy. These PLC were divided into groups A, B and C according to the Child-Pugh classification. The ultrastructural changes in the duodenal mncosas of each group were rated and compared with those of the other groups. PLC with and without ultrastrnctural changes of duodenal mncosas were divided into a positive group and a negative group. Levels of plasma Alb, TBil, PT, plasma endotoxin, and blood ammonia of the PLC were detected and compared. Results There were 20 PLC each in groups A, B, and C. Ultrastructural changes of duodenal mncosas were found in 5 PLC of group A, 9 in group B and 17 in group C. Among the 60 PLC, 52% had some changes in their duodenal mucosas. The changes included decrease and rupture of the microvilli; also karyopyknosis, karyorrhexis, widening of the gaps of the tight junction and tumefactions of mitochonddons of duodenal mncosa epithelial cells. No ultrastructural changes of duodenal mncosas were found in the control group. The rate of changes in the three Child-Pugh class groups and in the control group were 25%, 45%, 85%, 0% respectively （P 〈 0.01）. The level of Alb of the positive group was significantly lower than that of the negative group （P 〈 0.01）. Levels of plasma TBil, PT, endotoxin and blood ammonia of the positive group were significantly higher or longer than those of the negative group （P 〈 0.01）. Levels of plasma Alb of the positive and negative groups were significantly lower than those of the control group （P 〈 0.01）. Levels of TBil, PT, plasma endotoxin and blood ammonia of the positive and negative groups were significantly higher or longer than those of the control group （P 〈 0.01）. Conclusion There were ultrastructural changes of duodenal mucosas in PLC, especially in end-stage PLC. Ultrastructural changes of intestinal mucosas in the PLC may have important pathophysiological and clinical significance.