功能性消化不良患者十二指肠嗜酸性粒细胞、嗜铬粒蛋白A阳性细胞数量变化及其意义

Alterations and Significance of Duodenal Eosinophils and Chromogranin A-positive Cells in Patients With Functional Dyspepsia

背景:流行病学资料显示功能性消化不良(FD)与肠易激综合征(IBS)症状重叠相当常见。研究发现FD患者十二指肠嗜酸性粒细胞(EOS)数量增多,而IBS患者则存在十二指肠嗜铬粒蛋白A(Cg A)阳性细胞密度降低。目的:探讨单纯FD和FD重叠腹泻型IBS(IBS-D)患者十二指肠EOS、Cg A阳性细胞数量的变化及其意义。方法:纳入2014年8月—2015年3月就诊于福建医科大学附属第一医院、符合罗马Ⅲ标准的新诊断FD患者和FD-IBS-D重叠患者,取十二指肠球部活检组织,分别以HE染色和免疫组化染色检测、计数EOS、Cg A阳性细胞,并分析其与临床症状的相关性。结果:28例FD患者和12例FD-IBS-D重叠患者纳入研究。FD-IBS-D组十二指肠球部EOS数量显著多于FD组[(43.83±7.34)/5HPF对(22.90±8.93)/5HPF,P<0.05],Cg A阳性细胞数量显著少于FD组[(13.03±5.87)/HPF对(19.85±9.18)/HPF,P<0.05]。Spearman相关系数分析显示十二指肠EOS数量与腹痛/腹部不适、腹泻等下消化道症状呈显著正相关,Cg A阳性细胞数量与上、下消化道症状均无明显相关性。结论:与单纯FD患者相比,FD-IBS-D重叠患者十二指肠球部EOS数量明显增多,Cg A阳性细胞数量明显减少,可能反映了两者间临床症状的差异。

Background： Epidemiological studies suggest considerable overlap between functional dyspepsia（ FD） and irritable bowel syndrome（ IBS）. Increased duodenal eosinophil counts have been observed in patients with FD,and the density of chromogranin A（ Cg A）-positive cells was reduced in duodenum in patients with IBS. Aims： To investigate the alterations and significance of duodenal eosinophils and Cg A-positive cells in patients with FD and FD-diarrhea-predominant IBS（ IBSD） overlap. Methods： Outpatients with FD and FD-IBS-D overlap who fulfilled Rome Ⅲ criteria from Aug. 2014 to Mar.2015 at the First Affiliated Hospital of Fujian Medical University were enrolled. Biopsy specimens were collected from the duodenal bulb for HE staining and Cg A immunohistochemical staining. Eosinophils and Cg A-positive cells were counted,and their associations with clinical symptoms were analyzed. Results： Twenty-eight FD patients and twelve FD-IBS-D overlap patients were enrolled in this study. Duodenal bulb eosinophil counts were significantly higher in FD-IBS-D overlap patients than in FD patients [（ 43. 83 ± 7. 34）/5 HPF vs.（ 22. 90 ± 8. 93）/5 HPF,P 0. 05 ],while the density of duodenal bulb Cg A-positive cells were significantly lower in FD-IBS-D overlap patients than in FD patients [（ 13. 03 ±5. 87）/HPF vs.（ 19. 85 ± 9. 18）/HPF,P 0. 05]. Spearman correlation coefficient analysis revealed that duodenal eosinophil counts were positively correlated with lower gastrointestinal symptoms such as abdominal pain/discomfort and diarrhea,whereas no correlations were found between density of duodenal Cg A-positive cells and both upper and lower gastrointestinal symptoms. Conclusions： Duodenal bulb eosinophil counts are increased and Cg A-positive cells are reduced in FD-IBS-D overlap patients than in non-overlap FD patients,which may implicate the difference in clinical symptoms between these two functional gastrointestinal disorders.