先天性巨结肠相关性小肠结肠炎的影响因素及作用机制

Study on the influencing factors and mechanism of Hirschsprung-associated enterocolitis

目的:研究先天性巨结肠相关性小肠结肠炎(Hirschsprung-associated enterocolitis,HAEC)发病的影响因素,并初步探讨可能的作用机制。方法:对114例行巨结肠根治术的患儿进行病史回顾及随访,应用logistic回归分析HAEC的相关影响因素,ELISA检测先天性巨结肠(Hirschsprung′s disease,HSCR)患儿扩张段组织中脂多糖(LPS)和紧密连接蛋白ZO-1的表达情况,通过Pearson相关分析评估两者的相关性。结果:114例患儿中69例未伴发小肠结肠炎,45例HAEC患儿(37.82%),其中仅在术前发作HAEC者23例(20.17%),仅在术后发作HAEC者10例(8.77%),术前和术后均有HAEC者12例(10.53%)。孕周和是否为常见型HSCR分型对HAEC发作的影响均无统计学意义(P>0.05),而纯母乳喂养则为HAEC及术前HAEC发作的保护因素(P<0.01和P<0.05)。术前HAEC组患儿扩张段组织中LPS水平高于无HAEC组(P<0.01),而ZO-1低表达,且LPS水平与ZO-1呈负相关(r=0.361,P<0.01)。18例纯母乳喂养组患儿扩张段组织中LPS水平低于20例非纯母乳喂养组患儿(P<0.01)。结论:纯母乳喂养是HAEC发病的保护因素,母乳可能通过降低LPS水平进而影响相关紧密连接蛋白表达,降低了HAEC的患病风险。

Objective:To investigate the influencing factors and mechanism of Hirschsprung-associated enterocolitis(HAEC).Methods:A total of 114 cases of HAEC patients treated with radical megacolon were collected.The influencing factors of HAEC were analyzed using logistic regression analysis method.The expression levels of Lipopolysaccharide(LPS)and tight junction protein(ZO-1)in the dilated segment tissue of children with Hirschsprung′s disease(HSCR)were detected using ELISA assay,and the correlations between which and HAEC were analyzed using the Pearson correlation analysis method.Results:Among 114 children patients,69 cases without HAEC and 45 cases with HAEC(37.82%)were identified,and the preoperative HAEC in 23 patients(20.17%),postoperative HAEC in 10 patients(8.77%)and preoperative and postoperative HAEC in 12 patients(10.53%)with HAEC were found.The differences of the gestational week and type of HSCR were not statistically significant(P>0.05),while the exclusive breastfeeding was a protective factor for HAEC and preoperative HAEC(P<0.01 and P<0.05).The expression level of LPS in the dilated segment tissue of preoperative HAEC group were higher than that of non-HAEC group(P<0.01),the expression level of ZO-1 was low,and the LPS expression level was negatively correlated with ZO-1(r=0.361,P<0.01).The expression level of LPS in dilated segment tissue of the exclusive breastfeeding group was lower than that of the non-proprietary breastfeeding group(P<0.01).Conclusions:The exclusive breastfeeding is a protective factor for the pathogenesis of HAEC.Breast milk may reduce the risk of HAEC by decreasing the expression level of LPS to further affect the expression of related tight junction proteins.