慢性胃炎3种证型胃黏膜上皮细胞超微结构观察

Observation on the microstructure of gastric mucosal epithelial cells in three types of TCM syndromes of chronic gastritis

目的:从胃黏膜上皮细胞超微结构变化角度研究慢性胃炎(CG)肝胃不和、脾胃气虚及脾胃湿热3种证型胃黏膜上皮细胞病理微观结构特征并探讨其演变规律。方法:32例CG 3种证型患者胃镜下分别在胃窦及胃体部取黏膜活检组织,快速尿素酶试验(RUT)检测幽门螺旋杆菌(Hp),光镜下观察胃黏膜组织病理学变化;透射电镜下观察胃黏膜上皮细胞超微结构变化。结果:胃镜下3种证型伴Hp感染、胆汁返流及黏膜糜烂例数未见统计学差异,脾胃气虚证未见胆汁返流病例。光镜下3种证型胃黏膜均伴Hp感染、黏膜糜烂、腺体萎缩、肠化(IM)和/或不典型增生(ATP),例数未见统计学差异。透射电镜下发现:1CG 3种证型之间、同一证型不同个体之间、同一个体不同胃黏膜上皮细胞之间,细胞微绒毛形态数量、细胞连接、胞浆基质、核及核仁形状大小或/和数量、核膜厚薄、异染色质与常染色质的分布及比例等均不完全相同。2均可见亮暗细胞现象、细胞凋亡、空泡变性、线粒体肿胀、主细胞粗面内质网扩张及溶酶体形成等,但严重程度及/或数量有所差异。肝胃不和证线粒体肿胀相对明显;脾胃气虚证线粒体数量及/或面积减少上皮细胞数量较多;脾胃湿热证凋亡细胞数量较多。3脾胃气虚证和脾胃湿热证局部上皮细胞增宽的间隙内均可见渗出物,前者渗出物较稀薄,后者渗出物浓缩呈团块状。结论:胃黏膜上皮细胞超微结构变化是CG证型及症状不同的病理微观结构基础。

Objective： To explore the pathological features of microstructure of gastric mucosal epithelial cells and evolvement rule of three types of chronic gastritis（CG） syndromes, such as disharmony of liver and stomach, deficiency of spleen qi and stomach qi and dampness-heat of spleen and stomach from the microstructural changes of gastric mucosal epithelial cells.Methods： Gastric mucosa tissues of 32 CG patients with three types of syndromes were collected from the gastric antrum and gastric body respectively under gastroscopy; Helicobectorpylori（Hp） was examined through rapid urease test（RUT）; pathological changes of gastric mucosa were observed under optical microscope, and microstructural changes of gastric mucosal epithelial cells were observed under transmission electron microscope（TEM）. Results： Under gastroscopy, there was no significant difference in the number of 3 types of syndromes with Hp infection, bile reflux and mucosal erosion. No bile reflux cases were found in the spleen and stomach qi deficiency syndrome group. Under optical microscope, the pathological diagnosis were all CG, there were no significant differences in the number of three types of CG with Hp infection, mucosal erosion, glandular atrophy, intestinal metaplasia（IM） and atypical hyperplasia（ATP）. Under TEM： 1CG among three types, the same syndrome between different individuals, the gastric mucosal epithelial cell connection, cytoplasmic matrix, nuclear and nucleolar shape size or/and number, nuclear membrane thickness, and heterochromatin and euchromatin distribution and proportion were not exactly the same. 2light and dark cell phenomenon, cell apoptosis, cell vacuolar degeneration, dilation of rough endoplasmic reticulum in the main cells were observed, and lysosomal formation was common in gastric mucosal epithelial cells of three types of CG. However, the severity and/or quantity was different. Mitochondria swelling was relatively obvious in the syndrome of disharmony of liver and stomach. The number of epithelial cells with mitochondria reduced in the number and/or area was relatively large in the syndrome of deficiency of spleen qi and stomach qi. The number of apoptotic cells increased obviously in the syndrome of dampness-heat of spleen and stomach. 3In the syndromes of spleen and stomach qi deficiency and dampness-heat, exudate was seen in the widened intercellular space of the local epithelial cells. The former exudation was thin, and the latter was concentrated in a lump. Conclusion： The ultrastructural changes of gastric mucosal epithelial cells were the basis of the pathological and histological structures of the three different types of CG.