肠易激综合征患者肠黏膜超微结构改变的电镜观察

Ultrastructural changes in the intestinal mucosa of patients with irritable bowel syndrome

目的观察肠易激综合征(IBS)患者小肠和结肠黏膜杯状细胞、浆细胞、神经内分泌细胞和肥大细胞超微结构的变化,探讨它们在IBS发病机制中的作用。方法用活检钳分别钳取IBS患者腹泻型、便秘型和对照组各10例回肠末端及升结肠黏膜,在透射电镜下观察肠黏膜杯状细胞、浆细胞、神经内分泌细胞和肥大细胞超微结构的变化。结果与正常组比较,两型IBS患者结肠和小肠黏膜上皮均可见到杯状细胞内黏液泡和融合的黏液分泌泡明显增多;神经内分泌细胞和肥大细胞超微结构有改变,呈现功能活跃状态。4例发病前有急性感染性腹泻病史的腹泻型IBS,肠黏膜中浆细胞多见,并有超微结构的改变。结论小肠和结肠黏膜内杯状细胞、浆细胞、神经内分泌细胞、肥大细胞等超微结构的改变,可能在IBS症状发生的神经免疫、内脏感觉过敏等机制中有一定的作用。

Objective To study the ultrastructural changes including chalice cell, plasma cell neuroendocrine cell and mast cell in the intestinal mucosa of patients with irritable bowel syndrome （IBS）, and elucidate their possible effects on the pathogenesis of IBS. Methods Of 10 normal controls, 10 constipation predominant IBS （IBS-C） and 10 diarrhea predominant IBS（IBS-D）, biopsies were taken from the terminal ileum and ascending colon. Under electron microscope, we observed the ultrastructural changes including chalice cell, plasma cell, neuroendocrine cell and mast cell of the intestinal mucosa. Results In both colonic mucosa and small intestinal mucosa of patients with IBS, mucocysts and fused mucocysts were obviously increased in the chalice cells, of which the secretion was abundant. The neuroendocrine cells and mast cells were also observed in the mucosa of colon and small intestine, which were accompanied with ultrastructural changes. In 4 IBS-D patients with history of acute infectious diarrhea, more plasma cells with ultrastructural changes were found in the intestinal mucosa. Conclusion The ultrastructural changes of chalice cell, plasma cell, neuroendocrine cell and mast cell may have a potential effect on neuro-immunologic mechanism and visceral hypersensitivity of IBS.