胃窦幽门腺组织学和超微结构的增龄变化研究

Age-associated changes in the histology and ultrastructure of pyloric glands

目的 探讨人体胃窦幽门腺组织学和超微结构的增龄变化特点. 方法 选择拥有相对正常胃组织的60例患者为研究对象,包括中青年组（20～59岁）20例,老年组（≥60岁）40例.老年组包括60～69岁组15例,70～79岁组13例,80～89岁组12例.在光学显微镜下测定各组胃窦固有膜厚度、幽门腺实质比,对比观察各组胃窦固有膜、幽门腺及腺细胞形态;在电子显微镜下对比观察各组幽门腺细胞的超微结构. 结果 胃窦固有膜厚度20～59岁组为（649.8±127.9）μm,60～69岁组为（634.6±121.4）μm,70～79岁组为（615.7±74.6）μm,随增龄呈降低趋势;但80～89岁组为（645.5±99.9）μm,与20～59岁组相当（t=0.080,P=0.937）.幽门腺实质比从20～59岁组、60～69岁组、70～79岁组到80～89岁组呈明显随增龄降低趋势,依次为（37.6±6.5）％、（34.7±5.0）％、（31.5±6.4）％和（28.3±4.7）％（F=5.010,P=0.005）;老年组幽门腺实质比例明显低于中青年组（t=3.181,P=0.003）.光学显微镜下显示,老年各亚组（尤其是80～89岁）与中青年组比较,胃窦固有膜内幽门腺腺体排列较稀疏,间质结缔组织增生明显,幽门腺细胞核增大、深染、细胞边界模糊.电子显微镜下显示,各组幽门腺细胞及与分泌黏液相关的细胞器形态分布无明显差异;定量测定黏原颗粒面积分数显示呈明显随增龄降低趋势（F=19.831,P=0.000）,老年组（25.68±4.62）％明显低于中青年组（34.66±4.34）％（t=-6.456,P=0.000）. 结论 随增龄,人体胃窦固有膜厚度有降低趋势,幽门腺腺体密度逐渐降低,腺体间结缔组织增生逐渐增加,幽门腺细胞内与分泌黏液有关的黏原颗粒密度逐渐降低,提示老年人胃窦黏膜及其功能腺体在形态学上存在退化现象.

Objective To investigate the aging changes in the histology and ultrastructure of pyloric glands.Methods Sixty subjects with relatively normal gastric tissues were enrolled,with 20 subjects in the younger group （20-59 years） and 40 subjects in the elderly group （≥60 years）.The latter group included 15 subjects aged from 60 to 69 years,13 subjects aged from 70 to 79 years and 12 subjects aged from 80 to 89 years.Under light microscopy,the histology and morphology of pyloric glands were observed to determine the thickness of the lamina propria and the Ap：Al ratio （Ap：area of the parenchyma,Al：the area of gastric mucosa lamina proprias）,and to compare the morphology of the lamina propria,pyloric gland and gland cells in each group.The ultrastructure of pyloric gland cells was examined under electron microscope.Results From 20-59 age group to 60-69 age group to the 70-79 age group,the thickness of the lamina propria showed a decreasing trend from [（649.8± 127.9） μm to （634.6±121.4） μm and to （615.7 ± 74.6） μm,respectively,F=0.270,P=0.765],but the thickness of the lamina propria in 80-89 age group was increased to （645.5± 99.9） μm,comparable to that in the 20-59 age group.From 20-59 to 60-69 to 70-79 to 80-89 age group,the Ap to Al ratio （%） showed a significant decreasing trend from [（37.6 ± 6.5） % to （34.7 ± 5.0） % to （31.5 ± 6.4） % to （28.3 ± 4.7） %,F=5.010,P=0.005] ; the average Ap to Al ratio in the elderly group was significantly lower（31.6±5.9） % than in the younger group（37.6±6.5） % （t=3.181,P=0.003）.Interstitial hyperplasia of the lamina propria,sparse arrangement of pyloric glands,pyloric glands cells nucleienlarged and deeply stained and fuzzy cell boundaries were more clearly seen in the elderly group （especially 80-89 age group） as compared with the younger group.There was no significant difference in the ultrastructure of pyloric gland cells among each group.The average Am：Ac ratio （Am：the area of mucous granule,Ac：the area of cytoplasm of pyloric gland cell） showed a decreasing trend with age （F=19.831,P=0.000）.The average Am：Ac ratio in the elderly group [（25.68±4.62） %] was significantly lower than that in the younger group [（34.66 ±4.34） %] （t=-6.456,P =0.000）.Conclusions Along with aging,the thickness of the lamina propria has a decreasing trend,the density of pyloric glands is gradually decreased,while the connective tissue between the glands is increased.The density of mucous granules in pyloric cells associated with mucus secretion is also decreased.Hence,in the elderly,gastric antral mucosa and its functional glands have deteriorated performance and morphology.