新生儿小肠造瘘肠组织GLP-2R和PepT1的表达变化

Expression and significance of GLP-2R and PepT1 in infantile intestinal enterostomy

目的 探讨GLP-2R及PepT1蛋白在新生儿期小肠造瘘患儿肠组织的表达变化规律,为患儿制定术后肠内营养支持方案提供参考.方法 收集2013年10月1日至2015年10月1日我院手术患儿资料,分为肠造瘘组（A1组,n=21）、肠造瘘同期对照组（A2组,n=20）、肠造瘘关闭组（B1组,n=18）及肠造瘘关闭同期对照组（B2组,n=10）,HE染色后测量小肠绒毛的高度及中段直径,计算绒毛表面积;免疫组化及Western blot方法检测小肠组织GLP-2R及PepT1表达.结果 A1、A2组平均年龄分别为（18.19±16.76）d和（17.55±23.29）d,B1、B2组分别为（107.67±53.65）d和（105.30±35.17）d.新生儿期小肠造瘘患儿以NEC、胎粪性腹膜炎、肠穿孔等肠道炎症疾病为主（76.19％）.相同年龄比较（A1组比A2组及B1组比B2组）,肠绒毛高度及表面积差异均无统计学意义（P＞0.05）;但随年龄增长,肠绒毛高度、表面积均有增加,即A1组比B1组及A2组比B2组,差异均有统计学意义（P＜0.05）;新生儿期造瘘组至关造瘘时肠绒毛高度增加了29.27％,肠绒毛表面积增加了56.32％.小肠组织中GLP-2R和PepT1蛋白表达在新生儿期小肠造瘘组（A1组）均低于对照组（A2组）（P=0.036及P=0.024）;至造瘘关闭时与对照组比较（B1组比B2组）,两蛋白表达差异已无统计学意义（P=0.559及P=0.112）;随年龄增长,GLP-2R和PepT1蛋白表达均增加,差异有统计学意义（P＜0.05）;新生儿期造瘘组至关造瘘时GLP-2R与PepT1蛋白相对表达量分别增加了54.44％和56.20％.对照组则分别增加了34.37％及40.93％.结论 新生儿小肠造瘘时肠组织内GLP-2R和PepT1表达量略低,随年龄增长至关造瘘时,能达到未造瘘患儿水平.年龄越大,小肠组织内GLP-2R和PepT1表达量越多.

Objective To explore the expression of GLP-2R and PepT1 to provide theoretical rationales for enteral nutrition for infants undergoing intestinal enterostomy during neonatal period.Methods The intestinal tissues were collected from October 1,2013 to October 1,2015.The infants were divided into 4 groups of intestinal enterostomy （A1,n =21）,intestinal enterostomy control （A2,n =20）,closing intestinal enterostomy （B1,n =18） and closing intestinal enterostomy control （B2,n =10）.The underlying causes were analyzed and then height and middle diameter of villi measured for calculating the surface area of villi after hematoxylin ＆amp; eosin staining.The expressions of GLP-2R and PepT1 in intestinal tissue were detected by immunohistochemistry and Western blot.The differences of height of villi,surface area of villi and expressions of GLP-2R and PepT1 were compared among all groups.The variation of height of villi,surface area of villi and expressions of GLP-2R and PepT1 were explored in different ages and disease types.Results The average ages of groups A1 and A2 were （18.19 ± 16.76） and （17.55 ± 23.29） days.And the average ages of groups B1 and B2 were （107.67 ± 53.65） and （105.30 ± 35.17） days respectively.Neerotizing enterocolitis,meconium peritonitis and intestinal perforation were the major causes and intestinal inflammatory diseases accounted for 76.19%.Comparisons by different diseases at the same age：the differences between height and surface area of villi had no obvious statistical significance between groups A1 and A2.Or was between groups B1 and B2 （P〉0.05）.The height and surface area of villi increased with age （P〈0.05）.The differences of height and surface area of villi were statistically significant between groups A1 and B1.Or was between groups A2 and B2 （P〈0.05）.Villus height increased 29.27% and surface area increased 56.32% until closure of enterostomy.The expressions of GLP-2R and PepT1 in intestinal tissue of group A2 were significantly lower than those of group A1 （P =0.036,P =0.024）.Upon closing intestinal enterostomy,the expressions of GLP-2R and PepT1 had no statistical significance between groups B1 and B2 （P =0.559,P =0.112）.The expressions of GLP-2R and Pep T1 were higher in elder participants.And the differences were statistically significant between groups A1 and B1.And the same outcome was found between groups A2 and B2 （P〈0.05）.The expressions of GLP-2R and PepT1 increased 54.44% and 56.20% respectively.Conclusions The protein expressions of GLP-2R and PepT1 are slightly down-regulated in intestinal tissue during enterostomy.And they may reach the level of control group until closing intestinal enterostomy.The expressions of GLP-2R and PepT1 increase with age.