肠神经相关因子在出口梗阻型便秘直肠肌壁中的表达

Expression of intestinal nerve related factors in rectal muscle wall of outlet obstructive constipation

目的 分析肠神经相关因子在出口梗阻型便秘(OOC)直肠肌壁中的表达。方法 选取2018年3月至2020年2月我院收治的36例以直肠黏膜内脱垂为主要病因的OOC手术患者为试验组,另选取同期收治的36例混合痔手术患者为对照组。取试验组直肠黏膜内脱垂段直肠肌壁及对照组直肠肌壁的黏膜固有层、黏膜下层、肌层组织行神经元特异性烯醇化酶(NSE)、S-100蛋白染色。比较两组的NSE、S-100蛋白染色阳性细胞积分光密度值(IOD)及数量;分析OOC患者的肠神经系统(ENS)神经纤维及神经节显微镜下改变。结果 试验组的直肠肌壁黏膜固有层、黏膜下层、肌层S-100蛋白、NSE染色阳性细胞IOD低于对照组(P<0.05)。试验组的直肠肌壁黏膜固有层、黏膜下层、肌层S-100蛋白、NSE染色阳性细胞较对照组少。显微镜下显示,试验组的直肠黏膜内脱垂段肌壁间神经纤维束分布明显紊乱,显著增生,形态扭曲成波浪状;直肠黏膜内脱垂段肠壁黏膜固有层中神经节增生、粗大,染色变深。结论 OOC患者直肠肌壁中NSE、S-100蛋白表达下调,肌层中神经纤维及神经节功能代偿性增加,可能与中枢神经系统的分化障碍有关。

Objective To analyze the expression of intestinal nerve related factors in rectal muscle wall of outlet obstructive constipation(OOC).Methods Thirty-six patients with OOC surgery with internal rectal mucosal prolapse as the main cause admitted in our hospital from March 2018 to February 2020 were selected as the experimental group,and 36 patients with mixed hemorrhoids surgery admitted during the same period were selected as the control group.The lamina propria,submucosa and muscular layer of rectal muscle wall of internal rectal mucosal prolapse in the experimental group and rectal muscle wall in the control group were stained with neuron-specific enolase(NSE)and S-100 protein.The integral optical density(IOD)and number of NSE and S-100 protein staining positive cells in the two groups were compared;the changes of enteric nervous system(ENS)nerve fibers and ganglions in OOC patients were analyzed under microscope.Results The IOD of S-100 protein and NSE staining positive cells in the lamina propria,submucosa and muscular layer of rectal muscle wall in the experimental group were lower than those in the control group(P<0.05).The positive cells of S-100 protein and NSE staining in the lamina propria,submucosa and muscular layer of rectal muscle wall in the experimental group were less than those in the control group.Under the microscope,the distribution of nerve fiber bundles in the inter muscular wall of the internal rectal mucosal prolapse segment in the experimental group was significantly disordered,significantly proliferated,and the shape was twisted into a wavy shape;the ganglions in the lamina propria of the internal rectal mucosal prolapse segment were proliferated,coarse,and stained darker.Conclusion The expression of NSE and S-100 protein in the rectal muscle wall of patients with OOC is down-regulated,and the function of nerve fibers and ganglions in the muscle layer is compensatoryly increased,which may be related to the differentiation disorder of the central nervous system.