肠易激综合征患者肠黏膜肥大细胞的光镜和电镜观察

目的 光镜、电镜下观察肠易激综合征(IBS)患者肠黏膜肥大细胞(MC)的改变及其与P物质(SP)免疫反应阳性纤维、P物质受体(SPR)阳性细胞的关系,探讨其在IBS病理生理机制中的可能作用和临床意义。方法 黏膜标本取自19名正常人和22例腹泻型IBS(D-IBS)患者、20例便秘型IBS(C-IBS)患者的回肠末端、回盲部、升结肠、乙状结肠,应用特殊组织化学染色法(甲苯胺蓝改良染色法)和免疫组织化学染色法分别对MC和SP、SPR进行染色,并应用彩色病理图像分析软件及免疫组织化学分析软件进行分析;采用石蜡连续切片及原位包埋法透射电镜观察MC与SP免疫反应阳性神经纤维的关系。结果 IBS患者回肠末端、回盲部、升结肠MC明显增多(P<0.01),乙状结肠MC无明显变化,IBS患者MC存在显著变异;IBS患者肠黏膜SP免疫反应阳性纤维表达增强(P<0.01);SP免疫反应阳性纤维与MC靠近或毗邻,有些存在“膜膜”接触,增强的阳性纤维强度、面积与MC的面积、密度密切相关;部分肥大细胞呈SPR反应阳性。结论 MC与SP免疫反应阳性神经纤维及其相互作用在IBS内脏高敏感的病理生理过程中可能具有重要作用。

Study on mast cells of intestinal mucosa in irritable bowel syndrome patients under light and electron microscope

Objective To investigate whether there are changes of the mast cells (MCs) and substance P ( SP) -ergic nerve terminals under light and electron microscopy, and to elucidate their possible roles in the pathogenesis of irritable bowel syndrome (IBS). Methods In 19 normal controls, 22 diarrhea predominant IBS ( D-IBS) and 20 constipation predominant IBS (C-IBS) , biopsies were taken from the terminal ileum, ileocecal junction, ascending colon and sigmoid colon. The MCs and the substance P (SP)-ergic nerve terminals, substance P receptor ( SPR) were stained by histochemical and immunohisto-chemical method respectively, and color image analyzer investigated the results qualitatively and quantitatively. The structure relation between the MCs and SP-ergic terminals was studied through an ultra-microscopy using in situs embedding technique and a light microscopic study in serial sections. Results The number of MCs in the terminal ileum, ileocecal junction, and ascending colon was significantly elevated in IBS (P <0. 01) , and MCs in IBS have prominent variations. Significantly increased the SP-ergic nerve terminals were found in intestinal mucosa of IBS compared to the control. The correlation between mucosal MC and SP-ergic nerve terminals was found, and MCs were close to these terminals in lamina propria, which were demonstrated SP - ergic nerve terminals. Some MCs were demonstrated SPR-positive cells. Conclusion The MCs and SP of intestinal mucosa may play an important role in the gut hypersensitivity in both motor response and visceral perception in IBS.