功能性消化不良患者十二指肠免疫细胞的变化

Quantity alterations of duodenal immune cells in patients with functional dyspepsia

目的探讨十二指肠黏膜嗜酸粒细胞、肥大细胞、上皮间淋巴细胞(IELs)在功能性消化不良(FD)患者中的变化。方法选择2011年5-6月泰安市中心医院收治的48例FD患者和21例健康志愿者进行回顾性研究,胃镜钳取十二指肠球部及降段黏膜组织,HE染色并计数黏膜嗜酸粒细胞及上皮间淋巴细胞,主要碱性蛋白免疫组化染色评判嗜酸粒细胞脱颗粒程度,甲苯胺蓝染色计数肥大细胞总数及脱颗粒的肥大细胞数。结果 FD及其两种亚型餐后不适综合征(PDS)及上腹痛综合征(EPS)患者中十二指肠降段黏膜嗜酸粒细胞数显著高于对照组(23.23±5.18 vs.19.48±5.06,22.65±5.81 vs.19.48±5.06,23.76±4.58 vs.19.48±5.06,P均<0.05);十二指肠降段黏膜嗜酸粒细胞脱颗粒比例显著高于对照组(26/48 vs.3/21,12/23 vs.3/21,14/25 vs.3/21,P均<0.05);十二指肠球部黏膜肥大细胞数显著高于对照组(120.94±13.31 vs.104.29±20.81,121.00±13.75 vs.104.29±20.81,120.88±13.13 vs.104.29±20.81,P均<0.05);十二指肠降段黏膜肥大细胞数显著高于对照组(123.28±13.40 vs.108.62±7.64,124.32±16.53 vs.104.29±20.81,122.24±9.54 vs.104.29±20.81,P均<0.05);十二指肠球部黏膜脱颗粒肥大细胞数显著高于对照组(60.23±5.10 vs.25.38±2.32,59.84±4.50 vs 25.38±2.32,60.58±5.66 vs.25.38±2.32,P均<0.05);十二指肠降段黏膜脱颗粒肥大细胞数显著高于对照组(66.97±5.30 vs.30.66±2.89,66.63±5.37 vs.30.66±2.89,67.28±5.32 vs.30.66±2.89,P均<0.05)。结论十二指肠降段黏膜嗜酸粒细胞、十二指肠球部及降段黏膜肥大细胞可能参与了FD的发病。

Objective To investigate the alterations of duodenal eosinophils and mast cells and intraepithelial lymphocytes（IELs）in patients with functional dyspepsia（FD）.Methods Fifty patients with FD and twenty-one healthy volunteers were selected from May 2011 to June 2011 in Taian City Central Hospital.All subjects underwent upper endoscopy and biopsy, eosinophils and IELs of the bulb （ D1 ） and second part （ D2 ） of duodenum were identified and counted by HE staining, major basic protein （ MBP ） immunostaining for eosinophil degranulation in D2, toluidine blue staining for mast cells and mast cells degranulation.Results Compared to controls, eosinophils were significantly increased in FD and postprandial distress syndrome（PDS）and epigastric pain syndrome（EPS）in D2（23.23 ±5.18 vs.19.48 ± 5.06,22.65 ±5.81 vs.19.48 ±5.06,23.76 ±4.58 vs.19.48 ±5.06;all P〈0.05）.Eosinophil degranulation rates were significantly increased in FD,PDS and EPS in D2（26/48 vs.3/21,12/23 vs.3/21,14/25 vs.3/21;all P〈0.05）.Mast cells were significantly increased in FD,PDS and EPS in D1（120.94 ±13.31 vs. 104.29 ±20.81,121.00 ±13.75 vs.104.29 ±20.81,120.88 ±13.13 vs.104.29 ±20.81;all P〈0.05）and D2（123.28 ±13.40 vs.108.62 ±7.64,124.32 ±16.53 vs.104.29 ±20.81,122.24 ±9.54 vs.104.29 ± 20.81;all P 〈0.05 ） .Mast cells degranulations were significantly increased in FD, PDS and EPS in D1 （60.23 ±5.10 vs.25.38 ±2.32,59.84 ±4.50 vs.25.38 ±2.32,60.58 ±5.66 vs.±25.38 ±2.32;P〈0.05）and D2（66.97 ±5.30 vs.30.66 ±2.89,66.63 ±5.37 vs.30.66 ±2.89,67.28 ±5.32 vs.30.66 ± 2.89;P〈0.05 ） .Conclusions Eosinophils in D2 and mast cells in D1 and D2 may be involved in the pathogenesis of FD.