肠易激综合征患者结直肠黏膜降钙素基因相关肽和P物质表达及与临床症状的相关性

CGRP and SP expression of colorectal mucosa in patients with irritable bowel syndrome and its correlation with clinical symptoms

目的观察不同分型肠易激综合征(IBS)患者结直肠黏膜降钙素基因相关肽(CGRP)和P物质(SP)表达差异,及其与IBS临床症状的相关性。方法选取2012年1月—-2014年12月湖北省黄冈市中心医院消化内科收治的IBS患者63例作为研究对象(IBS组),其中便秘型24例,腹泻型21例,混合型18例;结肠息肉电切术后复查者10例作为对照组。采用免疫组化检测结直肠黏膜CGRP和SP表达。结果颗粒状SP染色存在于细胞膜中,腺体细胞胞浆丰富、出胞现象明显。腺体周围棕褐色颗粒状SP,腺体个别细胞膜上棕褐色颗粒状SP。CGRP免疫阳性神经纤维呈棕黄色颗粒状、圆形、椭圆形或无规则形,聚集或分散于黏膜腺体之间,腹泻型IBS组CGRP表达显著增加。腹泻型IBS患者CGRP、SP在回盲部和乙状结肠表达量显著高于便秘型、混合型IBS和对照组(F_(CCRP)=21.64、3.41,F_(SP)=5.26、5.41,P<0.01);与CGRP、SP的低表达组、中表达组比较,高表达组在排便困难、腹痛、大便性状均有统计学差异(F_(CGRP)=3.85、31.76、13.929,F_(SP)=3.450、28.070、9.287,P<0.05)。CGRP与腹痛、大便性状呈正相关(r=0.999、0.999,P<0.05),与排便困难呈负相关(r=-0.993,P<0.05);SP与腹痛、大便性状呈正相关(r=0.997、0.984,P<0.05),与排便困难(r=-0.940,P<0.05)、排便次数(r=-0.997,P<0.05)呈负相关。结论腹泻型IBS患者结直肠黏膜CGRP和SP表达显著增高,其可影响患者的排便困难、腹痛和大便性状等症状。

Objective To investigate the expression of calcitonin gene-related peptide（CGRP） and substance P（SP） in colorectal mucosa in patients with different types of IBS , and the correlation between SP and CGRP and clinical symptoms of IBS .Methods 63 cases of IBS in our hospital from 2012 to 2014 in the Department of digestive medicine were selected , Constipation type IBS 24 cases, diarrhea type IBS 21 cases, mixed type IBS 18 cases,10 cases of colon polyps were selected as the control group .Immunohistochemistry was used to detect the expression of CGRP and SP in colorectal mucosa .Results Granular SP staining was found in the cell membrane , abundant in the cytoplasm of gland cells .The gland around Brown gran-ular glands SP , individual cell membrane Brown granular SP .CGRP immunoreactive nerve fibers were brownish yellow granu-lar, round, oval or irregular shape , aggregation or scattered in the mucosal glands , CGRP expression of IBS group was signifi-cantly increased .Diarrhea predominant IBS patients CGRP expression was significantly higher than that of the constipation predominant IBS, mixed type of irritable bowel syndrome （IBS） and control group （P 〈0.01） in the ileocecal valve and sig-moid colon;Diarrhea predominant IBS patients SP expression was significantly higher than that of the constipation predominant IBS, mixed type of irritable bowel syndrome （ IBS） and control group （ F CGRP =21.64,3.41, F SP =5.26,5.41,all P 〈0.01） in the ileocecal valve and sigmoid colon; CGRP, SP high expression group in defecation difficulty , abdominal pain, stool character were statistically significant difference from low expression group , moderate expression group （ F CGRP =3.85, 31.76,13.929, F SP =3.450,28.070,9.287, P 〈0.05）.CGRP were positively correlated with abdominal pain ,bowel move-ment traits（ r =0.999, r =0.999, P 〈0.05）, and negatively correlated with defecation difficulties （ r =-0.993, P 〈0.05）;SP were positively correlated with abdominal pain ,defecate traits（ r =0.997, r =0.984, P 〈0.05）,and negatively＆nbsp;correlated with difficult defecation （ r =0.940, P 〈0.05）, stool frequency（ r =-0.997, P 〈0.05）.Conclusion The expression of CGRP and SP was significantly increased in patients with diarrhea type IBS , SP and CGRP can affect the defeca-tion difficulties , abdominal pain and stool characteristics and other symptoms .