肠道Cajal间质细胞与慢性便秘发生和治疗的关系

Relationship between interstitial cells of Cajal and development and treatment of chronic constipation

慢性便秘(chronic constipation,CC)是一种以腹胀、排便困难、肛门梗阻感、排便不尽感或排便干硬为主要表现的消化系统功能性疾病[1],按其病理生理主要分为慢传输型便秘(slow transit constipation,STC)、出口梗阻型便秘(outlet obstructive constipation,OOC)、正常传输型便秘(normal transit constipation,NTC)及混合型便秘(mixed constipation,MC)[2]。

Interstitial cells of Cajal(ICC)constitute networks that are widely distributed within the submucosal,intra-muscular and inter-muscular layers of the gastrointestinal tract.The ICC are recognized as important elements in the generation and propagation of electrical slow waves,mediating neurotransmission from enteric motor neurons to smooth muscle cells.Chronic constipation(CC)is a functional bowel disorder in which symptoms of difficult,infrequent,or incomplete defecation predominate and the prevalence is expected to rise over the next few years due to population aging.More and more attention has been paid on CC because of its unclear pathogenesis,controversial diagnostic criteria,diversified treatment methods and long disease duration.The relationship between slow transit constipation,a type of CC,and ICC has been affirmed in the European Society of Neurogastroenterology and Motility(ESNM)guidelines on functional constipation in adults in 2019,and there is a growing research supporting this view in recent years.Chronic constipation is associated with loss and injury to ICC which was approved via the synchronous changes in the number of ICC and the occurrence of CC in animal model and patients.In current studies,the change of ICC number,molecular expression and ultrastructure were found through a variety of treatment methods for CC,such as stimulant laxatives,bulking agents and osmotic laxatives,prokinetics,secretagogues,biofeedback therapy,alternative treatments,modulation of microbiota and innovative treatment.But the mechanism of this change is still in the stage of vitro research.We review here the relationship between ICC and CC,placing emphasis on the mechanism and therapeutics in the pathophysiology and cytology,hoping to stimulate extensive research into mechanism and individualized treatment of CC.