梗阻性黄疸患者肠黏膜上皮细胞增殖与凋亡的研究

目的观察梗阻性黄疸患者肠黏膜上皮细胞增殖与凋亡的特点,揭示肠黏膜上皮细胞增殖、凋亡的改变在梗阻性黄疸患者肠黏膜屏障功能障碍中作用和意义。方法选择27例进行肝、胆、胰及胃肠道手术治疗的患者,分为梗阻性黄疸组(n=15,试验组)和非梗阻性黄疸组(n=12,对照组),分别于手术时取患者的小肠黏膜。HE染色观察患者的肠黏膜上皮形态学变化;TUNEL法检测肠黏膜上皮细胞凋亡活性;免疫组化检测Ki-67抗原的表达,测定肠黏膜上皮细胞增殖活性。结果与对照组相比,试验组的小肠黏膜绒毛间隙增大,明显不连续,广泛存在小凹陷,有少量绒毛脱落。粘膜腺体排列稀疏,粘膜萎缩变薄。肠粘膜损伤分级评分试验组(3.73±1.03)较对照组(1.08±0.79)明显升高,差异具有显著性(P0.01)。肠黏膜上皮细胞增殖指标Ki67,试验组(54.06±23.60)较对照组(225.42±110.44)明显降低,差异具有显著性(P0.01)。凋亡指数试验组(38.20±12.16)较对照组(9.67±4.33)明显增高,差异具有显著性(P0.01)。结论梗阻性黄疸患者存在肠粘膜上皮细胞增殖活性的下降和细胞凋亡的增加,是导致梗阻性黄疸患者肠黏膜屏障功能障碍的重要原因之一。

The study of epithelial cell proliferation and apoptosis in patients with obstructive jaundice

Objective To investigate the characteristics of intestinal epithelial cell proliferation and apoptosis in patients with obstructive jaundice of and reveal the significance of the change.Methods 27 cases of gastrointestinal operation treated patients were divided into obstructive jaundice group(n=15,experimental group) and non obstructive jaundice group(n=12,control group),were taken jejunal mucosa in patients during surgery.Intestinal epithelial morphology in patients were observed by using HE dying,TUNEL method was used to detect intestinal mucosal epithelial cell apoptosis activity;Immunohistochemical detection of Ki-67 antigen expression,determination of the proliferative activity of intestinal epithelial cells.Results Compared with the control group,the villus gap of small intestine increased and the villus was discontinuity in the test group.There were widespread Small Sag,and a small amount of lint shedding.in them.The mucous glands were sparse and the mucosal atrophy thinning.The Intestinal mucosal injury grading score of the test group(3.73±1.03) than the control group(1.08±0.79) was significantly elevated,the difference was significant(P<0.01).The intestinal epithelial cell proliferation index Ki67 in the test group(54.06±23.60) than the control group(225.42±110.44) was significantly lower,the difference was significant(P<0.01).The apoptosis index in test group(38.20±12.16) than the control group(9.67±4.33) increased obviously,the difference was significant(P<0.01).Conclusion Patients with Obstructive jaundice have the declined proliferation activity of intestinal epithelial cell and increased apoptosis ratio,which may be an important mechanism to cause intestinal mucosal barrier dysfunction in patients with obstructive jaundice.