胆碱能神经对反流性食管炎食管动力的影响

Role of endogenous cholinergic nerve in esophageal dysmotility with reflux esophagitis

目的 研究内源性胆碱能神经在反流性食管炎食管动力机制异常中的作用。方法 经下食管括约肌切开制备反流性食管炎的猫模型 ,用连续水灌注测压系统检测正常猫及反流性食管炎的猫食管体部动力 ;用分光光度法分别测定正常猫及反流性食管炎的猫食管中段、远段肌组织中的乙酰胆碱转移酶和乙酰胆碱酯酶活力。结果 反流性食管炎组食管远段平均收缩波幅度明显低于正常对照组 (P <0 0 0 0 1) ,食管远段传导速度低于正常对照组 (P <0 0 5 ) ;反流性食管炎时食管中段及远段肌组织中乙酰胆碱转移酶活力均低于正常对照组的中段及远段 (P <0 0 5及P <0 0 0 0 1) ,以远段更明显 (P <0 0 0 0 1)。反流性食管炎组食管中段及远段肌组织中的乙酰胆碱酯酶活力与对照组比较差异均无显著性 (P >0 0 5 )。结论 反流性食管炎可导致食管远段动力低下 ,内源性胆碱能神经功能异常是其重要机制之一。

Objective To study the role of endogenous cholinergic nerve in esophageal dysmotility with reflux esophagitis in a feline model. Methods In 16 healthy cats under ketamine anesthesia (20 mg/kg), the abdominal parts of lower esophageal sphincter were cut open to establish the animal model for reflux esophagitis; esophageal motility was measured respectively preoperation and post-esophagitis. The activities of choline acetyltransferase (CHAT)and acetylcholinesterase(ACHE) in medial and distal esophageal body muscle was measured respectively with spectrophotometry, and compared to the normal cats(n=8). Results Reflux esophagitis can make distal esophageal peristaltic amplitude decrease, the distal esophageal peristaltic amplitude of cats with reflux esophagitis [above LES 1 cm: (22.65±16.53)mm Hg;above LES 3 cm : (39.94±14.78) mm Hg, P<0.000 1] was significantly lower than that of normal cats [above LES 1 cm: (63.71±21.34) mm Hg; above LES 3 cm:(73.65±23.42)mm Hg] and the conducting velocity of distal esophagus was slower than that of normal cats [(1.04±0.36) cm/s vs (1.39±0.46) cm/s,P<0.05]. In the esophagus of reflux esophagitis group, CHAT activity was lower in the model, especially in the distal part [(81.01±22.03)U/g vs (230.13±30.10)U/g,P<0.000 1] and ACHE activity remains unchanged. Conclusion CHAT activity and pressure level were lower in the distal esophagus with reflux esophagitis compared to the normal cats. This study supported that reflux esophagitis can result in dysmotility of the distal esophagus and the abnormality of endogenous cholinergic innervation is one of the importantmechanisms as far as the disorder of esophageal movement in reflux esophagitis.