特发性慢传输便秘与寡神经元性肠肌丛神经节细胞缺乏症(英)

有研究表明 ,肠神经系统的某些改变与特发性慢传输便秘有关。为获取肠壁内神经丛结构成分的详细资料 ,作者用定量形态分析的方法比较了特发性慢传输便秘病人与正常对照的结肠神经系统。 10例特发性慢传输便秘病人的切除标本与 10例对照 (非梗阻性新生物 )用神经标记物蛋白基因产物行免疫组化染色。分别对肠肌层神经丛和粘膜下神经丛成分进行形态学分析 ,包括神经节、神经元、神经胶质细胞和神经纤维的定量。结果表明慢传输便秘病人单位肠管长度内的总神经节面积和神经元数量及每个神经节内的平均神经元数量在肠肌层神经丛和粘膜下外侧神经丛…     

先天性巨结肠肌间神经丛形态学观察及其意义

目的观察先天性巨结肠肌间神经丛形态学并分析其意义。方法对8例先天性巨结肠患者手术标本过行苏木素伊红(HE)染色和免疫组织化学S100蛋白染色,进行形态学观察。结果先天性巨结肠狭窄部肠壁肌间神经无神经细胞,可见增多的直径增粗无髓鞘纤维,呈波浪状弯曲。雪旺氏细胞增多,结肠扩张段肌间神经丛可见神经节细胞,神经纤维无明显增粗,数量无明显增多。结论先天性巨结肠肌间神经丛形态学明显异常改变,与无神经节细胞病变肠段结肠发育障碍有关。     

烧伤大鼠小肠肌间神经丛中一氧化氮合酶的组织化学研究

目的　探讨烧伤后大鼠小肠壁内一氧化氮合酶 (NOS)的活性及分布的变化规律。　方法　采用NADPH -黄递酶 (NDP)组织化学法和整装铺片技术对烧伤大鼠小肠壁内NOS的活性及分布进行定量和定位研究。　结果　NOS广泛分布于大鼠小肠壁内 ,主要定位于肌间神经丛。NOS阳性神经元多为圆形和卵圆形 ,神经纤维中多含有膨体 ,形成“串珠”样结构 ,且多与血管和肌纤维伴行。烧伤后肌间神经丛中NOS阳性神经元密度变化不显著 (P >0 .0 5 ) ,但神经元内NOS活性则显著下降(P <0 .0 5～ 0 .0 1) ,同时发现烧伤后NOS阳性神经元结构模糊 ,神经纤维断裂较多 ,未能形成完整的神经纤维网 ,神经纤维中NOS阳性膨体亦明显减少。结论　烧伤后大鼠小肠肌间神经丛中NOS阳性神经结构受损 ,神经元内NOS活性下降 ,同时一氧化氮 (NO)的释放途径亦存在障碍 ,这些变化可能与烧伤后肠道结构受损 ,功能障碍密切相关     

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     

慢传输型便秘结肠神经丝蛋白和S—100蛋白的表达及意义

目的：探索结肠慢传输型便秘的发病机制。方法：采用免疫组织化学方法研究３３例慢性传输型便秘的病人（ＳＴＣ组）和２５例非便秘性结肠（对照组）升、横、降及乙状结肠肌间神经丛内神经丝蛋白和Ｓ－１００蛋白的表达。并利用图像分析系统作定量分析。结果：ＳＴＣ组结肠ＨＥ染色显示肌间神经丛未见明显异常，免疫组织化学染色示，对照组各段肠壁肌间神经丛内神经丝蛋白和Ｓ－１００蛋白的含量较恒定（Ｐ〉０．０５）。ＳＴＣ组结肠各段与对照比较。神经丝蛋白的含量无明显减少（Ｐ〉０．０５），但出现堆积聚集现象，平均光密度明显高于对照组（Ｐ〈０．０１）；Ｓ－１００蛋白的含量及平均光密度明显高于对照组（Ｐ〈０．０１）。且随着病程的延长而增加，二者呈直线相关（Ｐ〈０．０２）。结论：ＳＴＣ结肠肌间神经丛的病理改变是全结肠性改变。神经丝蛋白的堆积聚集和神经     

Cajal间质细胞在大鼠"泻剂结肠"结肠肌电变化中的作用

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 .0 5 ) ,肌间丛ICC分布不均匀 ,突起连接杂乱 ;电镜下见肌间丛神经轴突空化 ,ICC样细胞变性。结论　长期服用酚酞可导致结肠慢波频率减慢 ,其可能机理为肌间丛神经及ICC变性所引起     

结肠冗长的特发性便秘的结肠形态病理学分析

目的 研究表现为结肠冗长的特发性便秘的结肠形态病理学改变。方法 选取14例原发性结肠冗长病例与10例不伴便秘与梗阻的结肠癌病例作为对照,通过肉眼及HE染色后显微镜观察和图像分析,比较两组的异同点。并通过定量测量和统计学分析得出显著性结果。结果 原发性结肠冗长病例外观正常,显微镜下突出的改变为5例肌间神经丛中可见巨大的神经节细胞。图像分析结果显示其粘膜下血管面积、神经丛面积和神经节细胞数,肌间神经丛面积和神经节细胞数均显著大于对照组,肌层厚度则无显著性差异。结论 原发性结肠冗长有其特征性的神经病理学改变,进一步支持了特发性便秘是一种神经系统异常性疾病的论断。     

运脾颗粒对脾虚型慢传输型便秘小鼠SP和VIP含量的影响

为观察运脾颗粒对脾虚型慢传输型便秘小鼠肠道传输功能及结肠组织中P物质（sP）和血管活性肠肽（VIP）含量的影响,探讨运脾颗粒治疗脾虚型慢传输型便秘的药效与机制,为该药治疗便秘提供科学依据。采用复合造模法建立小鼠脾虚型慢传输型便秘模型,将小鼠分为空白对照组（A组）、模型对照组（B组）、麻仁对照组（c组）、运脾颗粒大剂量组（D组）、运脾颗粒中剂量组（E组）、运脾颗粒小剂量组（F组）,分别灌服相应药物,末次灌胃后测量肠道墨汁推进率;按放射免疫试剂盒方法分别测出结肠组织匀浆中SP、VIP的含量。结果显示,运脾颗粒能明显提高小鼠肠道传输功能,D组效果优于C组（P〈0．05）。运脾颗粒可明显增加便秘模型小鼠结肠组织中SP及VIP的含量,D、E、F组均优于c组（P〈O．05）,D组最明显（P〈0．01）。结果表明,运脾颗粒能明显提高小鼠肠道传输功能,且各项指标均优于C组（P〈0．05）,其机制可能是通过升高慢传输型便秘小鼠结肠中SP及VIP的含量来提高肠道传输功能。     

慢传输型便秘结肠肌间神经丛的超微病理研究

慢传输型便秘（ＳＴＣ）病因不清、症状顽固、临床处理较困难。为了进一步探讨其发生和发展的病理学基础，我们应用电镜技术对１４例ＳＴＣ患者和１１例非梗阻性直肠癌患者经手术切除的乙状肠标本进行了对照研究。与对照组相比，ＳＴＣ患者结肠肌间神经丛的超微病理改变表现为：①神经元及其突起有十分明显的退行改变。轴突及树突空化呈网络状结构，胞质内出现空泡及奚褐素等；②轴突末端膨体及突触前区内突触小泡含量明显减少，大部     

人工体神经-内脏神经反射弧建立后大鼠盆神经节-膀胱神经通路和递质研究

目的 观察人丁体神经-内脏神经反射弧建立后大鼠膀胱和盆神经节(MPG)之间的神经通路及神经递质性质.方法 8只成年wistar大鼠在体建立人工体神经-内脏神经反射弧.将辣根过氧化物酶(HRP)注射至实验大鼠的膀胱壁肌层,逆行神经追踪,通过免疫组织化学或组织化学方法显示HRP阳性标记细胞中的胆碱已酰转移酶(ChAT)、酪氨酸羟化酶(TH)、血管活性肠肽(VIP)、P物质(SP)和还原型辅酶Ⅱ(NADPH,NOS标志物).结果 支配膀胱的神经元多位于MPG主体部,呈圆形或椭圆形,无明显突起,多数为ChAT(40.1%,112/279)和TH(20.4%,50/245)免疫阳性,少数为VIP(10.7%,25/233)、NOS(6.5%,15/230)、SP(3.3%,8/242)反应阳性.结论 人工体神经-内脏神经反射弧建立后MPG中支配膀胱的神经元以胆碱能和肾上腺素能为主,VIP、SP和一氧化氮(NO)可能发挥神经调质作用.     

Immunohistochemical study of intralaryngeal ganglia in the cat.

To study the mechanism of autonomic regulation in the larynx, intralaryngeal local ganglia of the cat were investigated using immunohistochemical techniques. Small intralaryngeal ganglia were found in the peripheral portions of internal branches of the superior laryngeal nerve. Ninety-one percent of the ganglionic neurons were immunoreactive (IR) to vasoactive intestinal polypeptide (VIP), and 10% of the VIP-IR cells were also immunoreactive to enkephalin (ENK) and/or substance P (SP). The immunoreactivity of neuronal cell bodies remained unchanged even after denervation of the bilateral superior and recurrent laryngeal nerves. A dense distribution of calcitonin gene-related peptide (CGRP)-IR nerve fibers was found around almost all neuronal cells in the intralaryngeal ganglia. A few VIP-IR, ENK-IR, and SP-IR nerve fibers were also observed. Only the CGRP-IR fibers disappeared after the denervation experiments. In the laryngeal glands and mucosal arterioles, VIP-IR nerve terminals were found that were also immunoreactive to ENK and/or SP. However, these immunoreactive nerve endings in the glands and arterioles remained after the denervation experiments. The results of our study indicate that laryngeal exocrine secretion and blood flow are regulated by postganglionic autonomic parasympathetic fibers from intralaryngeal ganglia that contain VIP alone or VIP with ENK and/or SP, and that these ganglionic neurons may be innervated by CGRP-IR extrinsic nerve fibers.     

黄芪润肠丸治疗慢传输型便秘的临床与实验研究

为探索黄芪润肠丸治疗慢传输型便秘（STC）的机理,进行了临床与实验研究。结果显示,黄芪润肠丸（治疗组）治疗STC有效率达92．5％,优于西沙必利（对照组）（P〈0．05）。动物实验表明,小鼠排便颗粒数和炭末推进百分率治疗组均优于对照组和生理盐水组（空白组）;家兔结肠电波波幅和频率均高于正常组;治疗组小鼠结肠P物质（SP）和血管活性肠肽（VIP）物质含量均高于对照组。结果表明,由于黄芪润肠丸能通过提高结肠内SP和VIP物质含量,激活结肠电活动,加快结肠肠蠕动,故对STC有明显治疗作用。     

Rectal mucosal biopsy compared with laparoscopic seromuscular biopsy in the diagnosis of intestinal neuronal dysplasia in children with slow-transit constipation

BACKGROUND/PURPOSE: Intestinal neuronal dysplasia (IND) as a cause for severe chronic constipation remains controversial. The aim of this study is to examine the correlation between a deficiency of substance P (SP) immunoreactive nerve fibers in the colon and enzyme histochemistry of rectal biopsies in children with slow-transit constipation. METHODS: Fifty children with intractable constipation have been assessed by rectal biopsies examined with histochemical staining for lactate dehydrogenase, and 32 children among those 50 have been studied by laparoscopic seromuscular biopsy of the colon labelled with antibodies to SP using immunofluorescence methods. RESULTS: Four children have evidence of IND. Fifteen children, including all 4 IND cases, showed a deficiency of SP immunoreactivity. There is a significant correlation between giant ganglia and SP deficiency (P <.01). CONCLUSION: This study is attempting to propose that a deficiency of SP immunoreactivity in colonic circular muscle nerves may be used as a histologic marker for slow-transit constipation and that IND may be a small subset of patients with SP deficiency.     

慢传输性便秘的病理生理研究进展

慢传输性便秘（STC）是常见的慢性顽固性便秘类型,临床症状顽固。综合的保守治疗往往效果不佳．临床滥用泻剂的现象较为普遍．但最终导致便秘的进行性加重,手术切除动力缓慢的结肠是目前最终的治疗选择。STC的病理生理机制至今不完全清楚．给临床防治带来极大的困难。STC结肠动力异常可能源于神经体液调控障碍．部分病人可表现为全消化道动力障碍。研究发现STC结肠VIP、SP、NOS等多种肠神经递质分布或含量异常．Cajal间质细胞数量减少。但长期服用刺激性泻剂也可导致结肠壁内神经类似的变化．因此上述异常改变究竟存在怎样的内在联系仍然是今后研究的重点。     

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。     

烫伤大鼠垂体前叶P物质和降钙素基因相关肽神经的变化

目的　观察烫伤早期大鼠垂体前叶P物质 (SP)与降钙素基因相关肽 (CGRP)神经的形态分布变化。　方法　采用大鼠 30 %TBSAⅢ度烫伤模型 ,于伤后 1、2、6、10、12、2 4、72h 7个时相点 ,对垂体前叶SP和CGRP两种肽能神经行免疫组织化学染色观察 ;经图像分析测定 ,比较两种神经覆盖面积的变化。　结果　两种肽能神经的形态变化明显 ;伤后 1hSP、CGRP神经数目与对照相比分别增加 85 .7%和 6 0 .5 % ,神经纤维的膨体、分枝等明显增多 ;2h后减少 ,2 4h后趋于恢复。图像分析显示 :两种肽能神经的覆盖面积呈正相关变化 ,其基本变化趋势为伤后 1h升高 ,随后降低 ,伤后 12h降至最低点 ,然后回升。　结论　烫伤后早期大鼠垂体前叶的SP与CGRP神经形态分布发生明显变化 ,可能参与了全身应激反应的功能调节     

慢传输性便秘儿童结肠壁内脂肪酰胺水解酶的检测

目的 检测脂肪酰胺水解酶（FAAH）在慢传输性便秘（STC）患儿结肠壁内的表达及活性情况,并探讨其与儿童STC发生的关系.方法 取便秘组（21例）和对照组（15例）患者手术切下的结肠标本,应用免疫组织化学、Western blot及实时荧光定量PCR方法,对两组儿童结肠壁内FAAH的表达进行分析,并联合应用免疫荧光双重染色技术观察FAAH与大麻素受体1（CB1）的位置与分布,联合应用高压液相色谱技术对两组患儿结肠壁内FAAH的生物活性进行定量检测和分析.结果 便秘组升结肠、降结肠和乙状结肠肠壁中,Western印迹检测FAAH的蛋白表达分别为8.7±3.4、8.2±1.2和8.0±7.2,均弱于对照组的10.5±3.7、10.0±6.4和9.8±3.4,两组比较,差异有统计学意义（P＜0.05）;免疫组化和荧光定量PCR检测结果相同.FAAH在升结肠、降结肠和乙状结肠肠壁中的水解活性分别为（0.51±0.23）nmol·min^-1·mg^-1、（0.39±0.25）nmol·min^-1·mg^-1和（0.35±0.37）nmol·min^-1·mg^-1,低于对照组的（0.84±0.24）nmol·min^-1·mg^-1、（0.55±0.44）nmol·min^-1·mg^-1和（0.58±0.48）nmol·min^-1·mg^-1,两组比较,差异有统计学意义（P＜0.05）.结论 STC患儿结肠壁内FAAH的表达降低,水解活性减弱;FAAH可能参与了儿童STC的发生.     

Substance P and vasoactive intestinal peptide in rat small-bowel isografts

BACKGROUND: It is established that substance P (SP) is released by stimulation of nonadrenergic noncholinergic (NANC) excitatory nerves and vasoactive intestinal peptide (VIP) by stimulation of NANC inhibitory nerves. To evaluate the function of peptidergic nerves such as SP and VIP in small-bowel isografts, we examined the enteric nerve responses to SP and VIP in the isografted rat jejunum, using the normal rat jejunum as a control. METHODS: Orthotopic entire small bowel transplantation (SBT) with portocaval drainage was performed from Lewis rats to Lewis rats. Grafted tissue specimens were obtained 130 days after SBT (n = 9). As controls, normal segments of the jejunum were obtained from untransplanted Lewis rats (n = 22). A mechanograph was used to evaluate in vitro jejunal responses to electrical field stimulation of the enteric nervous system before and after treatments with various autonomic nerve blockers and neuropeptides (SP and VIP). RESULTS: SP concentration-dependently mediated the contraction reaction of NANC excitatory nerve in the isografted jejunum and to a lesser extent in the normal jejunum. In addition, there were significant diferences in the percentages showing contraction at 1 x 10(-8) and 1 x 10(-6)g/mL SP between the normal and isografted jejunal muscle strips (P < .05, respectively). VIP concentration dependently mediated the relaxation reaction of NANC inhibitory nerve in the normal jejunum and to a lesser extent in the isografted jejunum. In addition, there was a significant difference between the relaxation frequencies of the normal and those of isografted jejunal muscle strips at 1 x 10(-6) g/mL SP (P < .01). CONCLUSIONS: Contraction reactions of SP were observed in both the normal and isografted jejunum but were increased in the isografted jejunum. Relaxation reactions of VIP were also observed in both the normal and isografted jejunum but were decreased in the isografted jejunum. The increase of the effects of SP via NANC excitatory nerves and the decrease of the effects of VIP in mediating NANC inhibitory nerves may be largely related to the peristaltic abnormalities seen in the isografted LEW rat jejunum.     

Reinnervation of syngeneic pancreatico-duodenal grafts in rats

BACKGROUND: Knowledge on the reinnervation of transplanted organs is scarce, and the aim of the study was therefore to evaluate to what degree syngeneic pancreas grafts were reinnervated in rats. METHODS: Syngeneic pancreatico-duodenal transplantations were performed in normoglycemic Wistar-Furth rats. Native and transplanted pancreas and duodenum were removed 4 or 40 weeks after implantation, and processed for indirect immunofluorescence using antibodies directed against vasoactive intestinal peptide, substance P (SP), calcitonin gene-related peptide (CGRP), neuropeptide Y (NPY), tyrosine hydroxylase (TH), or the general neuronal marker protein gene product 9.5. RESULTS: Four weeks after transplantation a moderate to rich number of protein gene product 9.5-positive nerve fibers were found homogeneously distributed through the pancreas, probably representing the intrapancreatic nervous system, because the grafted pancreas lacked both a sympathetic (TH/NPY) and sensory (SP/CGRP) innervation 4 weeks after implantation. In a few of the animals there was a marked increase in SP-immunoreactive nerves (lacking CGRP), most conspicuous in the duodenal portion, both 4 and 40 weeks after transplantation probably secondary to a chronic pancreatitis. The fibers seemed to emanate from intrapancreatic ganglia and possibly also from enteric neurons in adjacent parts of the duodenum. A few scattered vasoactive intestinal peptide-containing nerve fibers probably also emanating from local ganglia could be seen throughout the grafted pancreas both 4 and 40 weeks after transplantation. At 40 weeks after transplantation sympathetic (TH- and NPY-positive) nerve fibers were regularly seen, whereas CGRP-positive nerve fibers were still virtually lacking in the pancreas. To trace the origin of the ingrowing nerve fibers, the tracer True Blue was injected into the grafted pancreas of some rats 38 weeks after transplantation, i.e., 2 weeks before killing. True Blue-labeled nerve cell bodies were numerous in the celiac ganglion (presumably sympathetic nerves) and few in dorsal root ganglia (sensory nerves). CONCLUSIONS: The data suggest that the transplanted rat pancreas becomes reinnervated by mainly sympathetic nerve fibers.