慢传输型便秘结肠肌间神经丛形态学改变及其临床意义

目的：探讨慢传输型便秘（ＳＴＣ）结肠传输缓慢的神经病理学基础。方法：对１４例ＳＴＣ患者的乙状结肠全层组织进行常规ＨＥ染色、肌间神经丛Ｈｏｌｍｅｓ银浸染色以及Ｓ－１００蛋白免疫组化染色等研究。并与１１例非梗阻性直肠癌患者的正常乙状结肠标本作对照。结果：１４例ＳＴＣ患者乙状结肠肌间神经丛嗜银性反应较对照组均有不同程度的降低，神经纤维排列紊乱并有缠结现象。肌间神经丛内Ｓ－１００蛋白的免疫反应性在ＳＴＣ组     

慢传输型便秘结肠肌间丛NOS、SOM、5-HT免疫反应性变化

目的　探讨一氧化氮（ＮＯ） 、生长抑素（ＳＯＭ）及５羟色胺（５ＨＴ） 在慢传输型便秘（ＳＴＣ） 发病中的作用。方法　用免疫组织化学法结合计算机辅助的图像分析技术检测１５ 例ＳＴＣ 患者乙状结肠肌间丛一氧化氮合酶（ＮＯＳ） 、ＳＯＭ 及５ＨＴ的免疫反应性变化。结果　与对照组相比,ＳＴＣ 患者乙状结肠肌间丛ＮＯＳ、５ＨＴ免疫反应性增强（ Ｐ＜ ０－０１ ,Ｐ＜ ０－０５） ,而ＳＯＭ 无显著差别（ Ｐ＞ ０－０５）。结论　ＮＯＳ及５ＨＴ 免疫反应性增强是ＳＴＣ 患者结肠传输减慢的神经病理基础,ＳＯＭ 在ＳＴＣ结肠动力减弱中的作用不明显。     

运动迟缓型便秘结肠神经系统胃泌素和P物质的分布观察

目的 探讨结肠壁内肌间神经丛和粘膜下神经丛胃泌素和Ｐ物质（ＳＰ）在运动迟缓型便秘（ＤＭＣ）中的神经病理变化。方法 应用胃泌素和Ｐ物质的兔多克隆抗体,对手术切除的１０例ＤＭＣ患者的结肠不同段和８例正常结肠的神经丛骨胃泌素和Ｐ物质进行免疫组化研究和相对半定量比较。结果 ＤＭＣ患者结肠肌间神经丝胃泌素和ＳＰ免疫反应阳性神经细胞明显减少,与正常结肠比较,差异有显著性意义（Ｐ〈０．０１）,粘膜下神经丛胃泌素和ＳＰ免疫反应阳性神经细胞两组差异无差异性意义（Ｐ〉０．０５）。常规ＨＥ染色下,ＤＭＣ结肠粘膜下有灶状炎症,肌间神经丛神经元空泡变性、减少,甚至消失。结论 ＤＭＣ患者结肠壁内存在明显的神经结构变化,其运动迟缓可能与肠壁内胃泌素和ＳＰ肽能神经元数量减少或功能障碍有关。     

慢性输型便秘乙状结肠壁内一氧化氮合酶分布的免疫组合研究

对１５例慢传输型便秘（ＳＴＣ）患者乙状结肠壁内一氧化氮合酶（ＮＯＳ）的分布进行免疫组织化学研究和半定量分析。结果表明肌间神经丛ＮＯＳ阳性细胞明显增多（Ｐ〈０．０５），粘膜下丛无明显变化（Ｐ〉０．０５）。提示一氧化氮的过量产生抑制了肠平滑肌的收缩，可能是ＳＴＣ以病的原因之一。     

尿毒症患者红细胞变形能力与膜磷脂和收缩蛋白变化的关系

探讨尿毒症患者红细胞变形能力（ＥＤ）与红细胞膜磷脂成分和收缩蛋白的关系。方法检测了４８例尿毒症患者和４０例健康人红细胞滤过指数（ＩＦ）、红细胞膜磷脂成分和收缩蛋白二聚体（ＳＰ－Ｄ）和四聚体（ＳＰ－Ｔ）相对含量的变化。结果尿毒症患者红细胞ＩＦ明显高于对照组（Ｐ＜０．００１），膜磷脂成分中神经磷脂（ＳＭ）、磷脂酰胆碱（ＰＣ）、磷脂酰丝氨酸（ＰＳ）和磷脂酰乙醇胺（ＰＥ）明显低于对照组（Ｐ＜０．０１），而ＳＭ／ＰＣ高于对照组（Ｐ＜０．０５）；尿毒症患者红细胞ＳＰ－Ｄ和ＳＰ－Ｄ／ＳＰ－Ｔ明显增高，而ＳＰ－Ｔ明显减低，与对照组比较有显著性差异（Ｐ＜０．０１）。尿毒症患者红细胞ＩＦ与ＳＭ、ＰＣ、ＰＳ、ＰＥ和ＳＰ－Ｔ呈负相关（Ｐ＜０．０５，０．０１），与ＳＭ／ＰＣ、ＳＰ－Ｄ和ＳＰ－Ｄ／ＳＰ－Ｔ呈正相关（Ｐ＜０．０１）。结论尿毒症患者ＥＤ降低与红细胞膜磷脂和收缩蛋白异常有关     

肾癌原癌基因C—erbB—2蛋白产物的表达及意义

为探讨肾癌原癌基因Ｃ－ｅｒｂＢ－２蛋白产物的表达及意义，采用免疫组化Ｓ－Ｐ（过氧化物酶－链霉卵白素）法对５５例肾癌组织中ＣｅｒｂＢ－２蛋白进行检测。显示Ｃ－ｅｒｂＢ－２蛋白呈局限性弱染色，表达率为２１．８％，与肿瘤直径相关（Ｐ〈０．０１），Ｒｏｂｓｏｎ分期Ⅰ，Ⅱ期肿瘤阳性表在明显高于Ⅲ，Ⅳ期肿瘤（Ｐ〈０．０５），随肿瘤分级增高阳性表达率呈递减趋势，颗粒细胞癌阳性表达率明显高于透明细胞癌（Ｐ〈０．０     

Cajal间质细胞在大鼠“泻剂结肠”结肠肌电变化中的 …

目的 研究长期服用接触性泻剂对大鼠结肠肌电的影响，探讨Ｃａｊａｌ间质细胞（ＩＣＣ）在“泻剂结肠”肌电变化中的作用。方法 ３２只大鼠随机分为２组，实验组饲以含酚酞饲料，３个月后测定结肠慢波频率及振幅；用碘化锌－锇酸法（ＺＩＯ）观察肌间丛ＩＣＣ变化，透射电镜观察肌间丛神经和ＩＣＣ的超微结构变化。结果“泻剂结肠”结肠慢波频率明显减慢（Ｐ〈０．０５），肌间丛ＩＣＣ分布不均匀，突起连接杂乱；电镜下见肌间丛神     

彩色多普勒监测胎儿窘迫时胎儿肺,肾,脑动脉血流动力学的变化

目的：探讨彩色多普勒监测胎儿窘迫时血流动力学的变化在围产儿监方面的价值。方法：仪器使用丹麦产维曼－７２５彩色多普勒超声诊断仪,监测胎儿;窘迫时脐动脉（ＵＡ）、肾动脉（ＲＡ）、脑动脉（ＣＡ）血流的Ｓ／Ｄ值、ＲＩ值、ＰＩ值,以胎儿窘迫１００例作为窘迫组,同期正常妊娠１００例作为对照组。结果：窘迫组ＵＡ、ＲＡ血流阻力指数较对照组均有显著升高（Ｐ〈０．０１,Ｐ〈０．０５）,ＣＡ血流Ｓ／Ｄ值显著升高（Ｐ〈０     

手术切除小细胞肺癌P53蛋白表达及意义

目的研究手术切除小细胞肺癌（ＳＣＬＣ）Ｐ５３蛋白表达，探讨其临床意义。方法取根治术后＞５年，术前未放疗、化疗标本３２例；石蜡切片，ＡＢＣ染色。结果Ｐ５３蛋白表达总阳性率８１．３％（２６／３２）；Ｐ５３蛋白表达与性别、吸烟、ＰＴＮＭ分期、淋巴结转移、原发病灶大小相关不显著（Ｐ＞０．０５）。术后２年内死亡组Ｐ５３阳性率１００％（１４／１４），＞５年死亡组４２．９％（３／７）（Ｐ＜０．０１）。前者死亡风险比后者高２倍。脑转移者Ｐ５３阳性率８５．７％（６／７）。结论Ｐ５３蛋白在ＳＣＬＣ中有高表达，它与ＳＣＬＣ术后的近期死亡及脑转移有关，对判断预后有帮助     

间隙连接蛋白Cx43在去卵巢雌鼠腺垂体滤泡星形细胞中的表达

目的 探讨间隙连接蛋白Ｃｘ４３在骨质疏松（ＯＰ）雌鼠腺垂体滤泡星形细胞（ＦＳ细胞）中的表达规律及其生物学意义。方法 采用１０月龄未孕产ＳＤ雌性大鼠４０只,随机分为去卵巢组和对照组,于术后６周处死两组大鼠。处死前测量大鼠全身骨密度。取大鼠垂体,应用ＳＰ免疫组化方法检测大鼠腺垂体ＦＳ细胞中间隙连接蛋白Ｃｘ４３的表达。结果 术后６周末去卵巢组大鼠全身骨密度明显低于对照组大鼠骨密度（Ｐ〈０．０１）。腺垂体     

慢传输型便秘乙状结肠壁内一氧化氮合酶分布的免疫组化研究

对15例慢传输型便秘(STC)患者乙状结肠壁内一氧化氮合酶(NOS)的分布进行免疫组织化学研究和半定量分析,结果表明肌间神经丛NOS阳性细胞明显增多(P<0.05),粘膜下丛无明显变化(P>0.05).提示一氧化氮的过量产生抑制了肠平滑肌的收缩,可能是STC发病的原因之一.     

顽固性慢传输性便秘的外科治疗及病因研究

目的研究顽固性慢传输性便秘(STC)的手术治疗结果及肠神经递质变化。方法回顾性分析我院近10年来手术治疗的34例STC病例特点、手术方式及效果,用免疫组织化学方法(免疫组化)研究肠神经递质变化。结果本组患者结肠传输均明显减慢,平均136h,85.3%的患者伴有出口梗阻性便秘(OOC),61.8%有性激素异常。免疫组化研究发现,肠壁内神经丛一氧化氮合酶(NOS)免疫反应阳性增强,血管活性肠肽免疫反应阳性降低。所有患者术后恢复良好,5例术后出现粘连性肠梗阻,1例术后便秘复发。结论外科手术治疗是STC内科综合治疗失败后的最后手段,为保证手术效果,术中应同时处理伴随的OOC;肠神经递质改变可能是STC发病的原因之一。     

17例传输性便秘外科治疗分析

目的 探讨慢传输性便秘（ＳＴＣ）的手术指征、手术治疗效果及可能的发病因素。方法 收集我院近年来手术治疗的１７例ＳＴＣ患者的临床资料,分析其病例特点、手术方式及预后。结果 本组患者大便次数每４￣１４天１次,所有患者均有长期服用泻剂史。８２．４％的患者伴有出口性便秘（ＯＯＣ）,结肠传输试验均延长,５０％有性激素异常。病理研究发现,肌间从嗜银性神经细胞减少,轴突空泡变性。所有患者术后恢复良好,３例术后出     

How common is colonic elongation in children with slow-transit constipation or anorectal retention?

PurposeColonic elongation is reported as a possible cause for slow colonic transit, as it is observed in patients with slow-transit constipation (STC). This study aimed to determine the frequency of colonic elongation in children with STC or anorectal retention using radioimaging. We hypothesized that transverse colon elongation may occur in patients with STC, whereas sigmoid colon elongates in patients with anorectal retention.MethodsNuclear transit scintigraphy performed for chronic constipation (1999-2011) was analyzed qualitatively for elongated transverse colon or sigmoid colon. Three major colonic transit patterns were identified: slow transit in the proximal colon (STC), normal proximal colonic transit with anorectal retention (NT-AR), and rapid proximal transit ± anorectal retention (RT). χ² Test was used for statistical analysis (P < .05 significant).ResultsFrom 1999 to 2011, 626 children had nuclear transit scintigraphy. Transverse colon elongation occurred more frequently in STC (73/322, or 23%) compared with NT-AR (9/127, or 7%) and RT (5/177, or 3%; P < .0001). Sigmoid colon elongation was equally common in NT-AR (8/127, or 6%) compared with RT (10/177, or 6%) and STC (14/322, or 4%; P < .9).ConclusionTransverse colon elongation is more common in STC (23%), whereas sigmoid colon elongation is not more common in anorectal retention. Colonic elongation may be the cause or the result of the underlying slow colonic transit.     

慢传输性便秘患者乙状结肠组织中Cajal间质细胞的分布

目的　了解Cajal间质细胞 (ICC)在慢传输性便秘 (STC)患者乙状结肠组织中的分布。方法　应用c kit单克隆抗体间接免疫荧光检测技术 ,对 12例STC患者和 8例对照组患者的乙状结肠组织中的ICC分布进行测定 ,激光共聚焦显微镜扫描图像 ,图像处理软件进行分析。结果　ICC广泛分布于结肠肌层中 ,包括纵肌层、肌间丛、环肌层和黏膜下环肌表面 ,形态主要表现为双极细胞和多突起细胞两种类型 ;肌间丛和环肌层ICC数量多于黏膜下环肌表面和纵肌层。与对照组相比 ,STC患者各个区域ICC均明显减少 (P <0 0 1)。部分病例黏膜下环肌表面ICC几乎消失。结论　STC患者结肠存在ICC减少 ,但ICC减少是原发性还是继发性有待探讨     

Assessing interstitial cells of Cajal in slow transit constipation using CD117 is a useful diagnostic test

Slow transit constipation (STC) is a colonic motility disorder that is characterized by measurably delayed movement of stools through the colon. The pathophysiology of STC is unclear and both the interstitial cells of Cajal (ICC) and cells of the enteric nervous system are believed to play an important role. The aim of this study was to compare the number and distribution of ICC and cells of the enteric nervous system in patients with a control group by means of immunohistochemistry. Formalin-fixed paraffin-embedded colonic sections were obtained from 15 patients, aged between 23 and 52 (mean age=37 y), who underwent colectomy for STC. Forty-five cases of normal colon from age and sex-matched nonobstructive colorectal cancer patients were selected as controls. By using c-kit (CD117) and PGP 9.5 immunohistochemical studies, ICC and enteric neurofilaments were demonstrated, respectively. The number of cells were counted under 40 x high-power field (HPF) in 3 layers of the colonic muscularis propria, that is, the inner circular muscle layer, the myenteric plexus, and the outer longitudinal muscle layer in both test and control groups. The mean number of ICC and enteric neurofilaments were significantly reduced in all 3 layers of the muscularis propria from STC patients compared with controls. This reduction was most significant in the inner circular muscle layer (P<0.0001). A cutoff value of 7 ICC per HPF in the inner circular muscle layer can be used as a further confirmation to the clinical diagnosis of STC in resected specimens.     

慢传输性便秘结肠平滑肌肌动蛋白改变

目的：深入地了解慢传输性便秘的发病机理和病理生理改变。方法：以免疫组化方法检测了STC患者结肠平滑肌收缩蛋白－肌动蛋白的变化。结果：与正常对照组相比,慢传输性便秘患者结肠黏膜下肌层、纵肌层内α肌动蛋白量明显减少（P＜0．01）,而环肌层内α肌动蛋白变化不明显（P＞0．05）。结论：推测这种平滑肌收缩蛋白的减少和分布异常导致了慢传输性便秘病人结肠运动功能的紊乱。     

Segmental colonic transit studies: comparison of a radiological and a scintigraphic method

OBJECTIVE: Colonic transit studies are used to diagnose slow transit constipation (STC) and to evaluate segmental colonic transit before segmental or subtotal colectomy. The aim of the study was to compare a single X-ray radio-opaque marker method with a scintigraphic technique to assess total and segmental colonic transit in patients with STC. METHOD: Thirty-one female patients (median age 46 years) with severe constipation and a prolonged or borderline prolonged colonic transit time on radio-opaque marker study were included in the study. They were subsequently investigated with (111)Indium-DTPA colonic transit scintigraphy, with a median time between the investigations of 4(range 1-27) months. Normal values of healthy female controls were used for comparison. RESULTS: There was no difference between the two methods in terms of prolonged or normal total colonic transit time. Twenty-nine of 31 female patients had a prolonged transit time only in one or two segments on the marker study. On scintigraphy, the transit time was prolonged for patients in the left (P < 0.05 to P < 0.001), but not in the right colon. With respect to prolonged or normal segmental transit time, there was a significant difference between the two methods only in the descending colon (P = 0.02). However, the results varied considerably for individual patients. CONCLUSION: Segmental colonic delay was a common finding. The two methods gave similar results for groups of patients, except in the descending colon. The variation of the results for individuals suggests that a repeated transit test may improve the assessment of total and segmental transit.