肠易激综合征小肠黏膜肠嗜铬细胞和肥大细胞的病理表现

Pathological manifestations of enterochromaffin cells and mast cells in small intestinal mucosa of patients with irritable bowel syndrome

目的:探讨肠易激综合征(IBS)患者小肠黏膜肠嗜铬细胞(EC),肥大细胞(MC)的数量和分布以及EC合成与储存5-HT的功能改变.方法:将符合罗马III标准的38例IBS患者分为:便秘型IBS18例(A组),腹泻型IBS20例(B组),另选20例因各种原因接受结肠镜和小肠镜检查均未见明显病变的健康者作为对照组(C组).通过小肠镜及结肠镜分别取小肠不同部位黏膜,应用免疫组织化学方法检测EC和MC,并用电子显微镜观察EC的功能.结果:①A组和B组每高倍镜视野下EC数量十二指肠降段黏膜分别为9.4±3.9,10.2±3.7,近端空肠黏膜为6.7±2.6,6.2±2.4,回肠末端黏膜为2.7±1.4,3.2±1.9,与C组各个部位EC数量10.5±3.4,6.6±3.4,3.1±1.7相比差异均无统计学意义(P>0.05).②A组和B组十二指肠降段黏膜EC功能比末端回肠活跃,与C组相似.③A组和B组每高倍镜视野下末端回肠黏膜MC数量38.7±9.4,35.8±5.5与C组29.8±4.4相比明显升高(P<0.01),但是A组和B组相比差异无统计学意义(P>0.05).A组和B组十二指肠降段黏膜MC数量分别为19.6±4.7,18.5±6.3,近端空肠黏膜MC数量为18.8±5.8,19.7±4.8,与C组MC数量19.2±3.3,20.0±6.9相比差异无统计学意义(P>0.05).结论:IBS患者小肠黏膜EC无明显改变,而末端回肠黏膜MC增多.IBS-C和IBS-D小肠黏膜EC和MC的病理变化相似.

AIM： To investigate the distributions and numbers of enterochromaffin cells （EC） and mast cells （MC）, and the functional status of EC in the small intestinal mucosa of patients with irritable bowel syndrome （IBS）. METHODS ： Eighteen constipation-predominant IBS patients （ group A）, 20 diarrhea predominant IBS patients （group B） and 20 healthy normal controls （group C） were selected as subjects according to Rome Ⅲ criteria. They all underwent colonoscopies and small intestinal endoscopies, and their mucosa samples at the descending part of duodenum, proximal end of jejunum and terminal ileum were obtained in the meantime. Immunohistochemical methods were used to detect EC and MC. EC were also observed under electron microscope for their functional status. RESULTS： （1） For each high power visual field, the numbers of EC in group A and B at the descending part of duodenum were 9.4 ± 3.9 and 10.2 ± 3.7 re- spectively, 6.7 ± 2.6 and 6.2 ± 2.4 at proximal end of jejunum, 2.7 -± 1.4,3.2 ± 1.9 at terminal ileum. Compared with those in group C （ 10.5 ± 3.4,6.6 ± 3.4,3.1 ± 1.7 respectively）, they did not have significant differences （ P 〉 0.05 ）. ~） Observed under electron microscope, EC in group A and B at the descend- ing part of duodenum were of more active functional status, com- pared with those at terminal ileum, which was similar to group C. （~） The numbers of MC in group A and B at terminal ileum were 38.7 ±9.4 and 35.8 ±5.5 respectively, which were significantly more than those in group C （29.8 ± 4.4, P 〈0.01 ）. But the numbers of MC in group A and B at terminal ileum did not have significant differences （ P 〉 0.05）. The numbers of MC at the descending part of duodenum in group A and B were 19.6 ±4.7 and 18.5 ±6.3 respectively, 18.8 ± 5.8 and 19.7 ± 4.8 at proximal end of jejunum. Compared with those in group C （ 19.2 ± 3.3, 20.0 ± 6. 9 respectively ）, they did not have significant differences （ P 〉 0. 05 ）. CONCLUSION ： Enterochromatgn cells show no significant change in small intestinal mucosa and mast cells increase at terminal ileum in patients with IBS. The pathological changes of EC and MC in the small intestinal mucosa of the patients with constipation-predominant IBS are similar to those in ones with diarrhea-predominant IBS.