Hirschsprung病肠壁中葡萄糖转运体-1和一氧化氮合酶阳性神经的变化憊

目的　观察葡萄糖转运体 1(GLUT 1)和一氧化氮合酶 (NOS)阳性神经在Hirschsprung病 (HD)肠壁中的变化并探讨二者与HD发病的关系。方法　应用还原型辅酶Ⅱ 黄递酶组织化学和免疫组织化学染色观察 9例HD及 5例对照组患儿结肠。结果　在正常结肠的肌层和粘膜下层内偶见细小的GLUT 1免疫反应性神经纤维 ,肠壁外的外源性神经纤维呈阳性染色 ;而在无神经节细胞肠段的相应区域内GLUT 1免疫反应性神经纤维数量明显增多、增粗。在正常结肠肠壁内有大量NOS阳性神经节细胞 ,环肌层内含有丰富的阳性神经纤维 ;而在无神经节细胞肠段的肠壁内缺乏NOS阳性神经元 ,肌层内阳性神经纤维明显减少。结论　肠壁内GLUT 1阳性神经可能为外源性神经 ,GLUT 1免疫组织化学染色可能对HD具有诊断价值。NOS阳性神经在病变肠壁中的分布异常可能与HD的病理生理机制有关。

Changes of Glucose Transporter-1 and Nitric Oxide Synthase Positive Nerves in the Colon of Hirschsprung's Disease

Objective To observe the changes of glucose transporter-1 (GLUT-1) and nitric oxide synthase (NOS) positive nerves in the colon of Hirschsprung's disease (HD) and their relation to the pathogenesis of HD. Methods Colons from 9 children with HD and 5 controls were stained by NADPH-diaphorase histochemistry and GLUT-1 immunohistochemistry, respectively. Results In the muscular and submucosal layers of ganglionic colons, only the fine nerves of GLUT-1 immunoreactivity were occasionally seen, but the exramural extrinsic nerves were always immunoreactive. In those areas of aganglionic specimens, GLUT-1 positive nerve fibers were remarkably increased both in number and size. There existed many NOS positive ganglion cells and full supplies of NOS positive nerves in the circular muscle layer in ganglionic colons, whereas the lack of NOS positive neurons and the obvious decrease of NOS positive fibers were observed in aganglionic ones. Conclusion The mural GLUT-1 immunoreactive nerves might be originated from extrinsic nerves. GLUT-1 immunohistochemical stain might be helpful in the diagnosis of HD. It is suggested that the abnormal distribution of NOS positive nerves in aganglionic bowel is involved in the pathogenesis of HD.