肥大细胞检测在先天性巨结肠小肠结肠炎中的临床意义

Mast cell in enterocolitis associated with Hirschsprung disease

目的探讨肥大细胞在先天性巨结肠小肠结肠炎发病机制的作用，为临床治疗提供依据。方法2004年5月-2006年5月在上海交通大学医学院附属新华医院行先天性巨结肠根治术中切除的狭窄段、移行段和扩张段肠管黏膜层标本，共30例。男23例，女7例，年龄1个月～7岁，平均1．2岁。短段型5例，普通型18例，长段型6例，全结肠型1例。根据术前有无小肠结肠炎临床症状将患儿分为巨结肠肠炎组（n=12）和非肠炎组（n=18）。肥大细胞采用甲苯胺蓝染色和免疫组织化学染色（chymase）染色。结果巨结肠肠炎组狭窄段、移行段和扩张段肥大细胞在黏膜，黏膜下及扩张的血管周围聚集，脱颗粒现象明显。非肠炎组结肠组织中肥大细胞在黏膜下，黏膜明显减少，脱颗粒现象轻微。结论肥大细胞在肠炎的发生中起一定的作用，采用肥大细胞抑制剂是一种新的临床治疗先天性巨结肠小肠结肠炎途径。

Objective To assess the role of mast cell and Hirschsprung＇s disease （HD） associated enterocolitis. Methods We studied 30 patients （23 boys and 7 girls） with HD admitted into our hospital between May 2004 and May 2006. There were 5 short-segment, 18 common type, 6 long-segment type and 1 total colon type HD. The patients were divided into enterocolitis group （n = 12） and non-enterocolitis group （n = 18）. The mast cells were immunostained with toluidine blue and chymase. Results The dilated vessels and the mast cells with degranulation were localized in mucosal and sub-mucosal layers in the enterocolitis group. In the non-enterocolitis group, the mast cells were mainly in submucosal layer and to less extent in the mucosal layer with minimal degranulation. Conclusions These results suggest that mast cells may be involved in the pathogenesis of Hischsprung＇s diseaseassociated enterocolitis.