非溃疡性消化不良患者胃窦壁内NO能、VIP能神经与胃排空关系的研究

The relationship between nerves containing nitric oxide synthase and vasoactive intestinal peptide in gastric antral wall and gastric emptying in patients with non-ulcer dyspepsia

目的探讨非溃疡性消化不良（NUD）患者胃运动障碍的发生机制。方法应用酶组织化学及免疫细胞化学方法结合图像分析系统对31例NUD患者（19例胃液体排空正常的患者为NUD1组和12例胃液体排空延迟的患者为NUD2组）及4例“正常”人胃窦壁内一氧化氮合酶（NOS，一氧化氮定位标志酶）、血管活性肠肽（VIP）进行了定位、定量研究。结果NUD2组患者胃窦粘膜肌内NOS、VIP阳性神经纤维比NUD1组、“正常”组明显增多、增粗，染色增强，粘膜下层易见到NOS阳性神经节细胞和丛内突起，NUD1组与“正常”组类似；NUD2组NO-S、VIP阳性神经的面积、平均吸光度值与NUD1组、“正常”组之间差异有显著性（P＜0．01）；胃液体半排空时间（T1／2）与三组NOS、VIP阳性神经的面积、平均吸光度值之间均有良好的相关性。结论胃液体排空延迟的NUD患者胃窦壁内NOS、VIP阳性神经纤维和末梢明显增多、活性增强。提示胃窦壁内NO能、VIP能抑制性神经异常改变在NUD患者的胃运动障碍中具有一定的作用。

Objective To study the mechanisms of gastric motor dysfunction in NUD. Methods Changes of nerves containing nitric oxide synthase (NOS) were studied using enzyme-histochemical and immunohistochemical methods and quantitatively measured with image analyzer. Biopsy specimens of mucosal muscular layers from gastric antrum of patients included control group (n=4), NUD groupl (patients with normal gastric liquid emptying, n=19) and NUD group2 (patients with delayed gastric liquid emptying,n=12). Results The nerve fibers-containing NOS, VIP increased significantly and their activities were stronger in the mucosal muscular layer of gastyic antrum of NUD groups2 than NUDI and control groups (P<0.01).NOS-Positive ganglial cells and nerve fibers were easily found in the submucosal layers of NUD group2. Gastric emptying half time (Tl/2) was closely correlated with the number of fiber-containing NOS, VIP, and the activity of NOS and immunoreactivity of VIP. Conclusion Abnormal changes of local inhibitory neurotransmitter (NO.VIP) in the gastric antrum of patients with NUD are closely correlated with the delayied gastric emptying, the nerves containing NOS,VIP in antrum play important roles in the pathologenetic mechanisms of NUD.