CAJ | 학술논문

目的探讨贲门失弛缓(AC)与肠间质细胞(ICC)及一氧化氮(NO)之间的关系,以进一步研究AC的发病机理.方法选取2011年8月至2011年12月收治的贲门失弛缓症患者16例,经口内镜下肌切开术术中取活检组织作为实验组标本;选取非食管动力障碍性疾病手术患者15例,切取食管下括约肌作为对照组标本.采用免疫组化染色法,显微镜下随机选取3个视野观察ICC和由一氧化氮合酶在两组食管下括约肌中的分布和表达情况,计算肠间质细胞的个数和半定量判定一氧化氮合酶的表达强度.结果光镜下观察,对照组食管下括约肌中有肠间质细胞分布,呈梭形,两端细长突起,弥散分布在肌层中,与肌束平行走向,部分肠间质细胞间突起相互连接,每切片平均计数(11.2±7.4)个.实验组中肠间质细胞分布稀疏,细胞突起不明显,每切片平均计数(5.8±5.6)个,与对照组比较差异有统计学意义(P=0.01).食管下括约肌中也可见一氧化氮合酶染色阳性神经纤维,对照组染色神经纤维粗大,染色深,实验组中神经纤维纤细,染色淡,分布稀疏,两组在染色强度上比较差异也有统计学意义(P=0.13).结论肠间质细胞和一氧化氮合酶在贲门失弛缓症患者食管下括约肌中分布和表达异常,两者可能与贲门失弛缓症发病有关.
목적 탐토분문실이완(AC)여장간질세포(ICC)급일양화담(NO)지간적관계,이진일보연구AC적발병궤리.방법 선취2011년8월지2011년12월수치적분문실이완증환자16례,경구내경하기절개술술중취활검조직작위실험조표본;선취비식관동력장애성질병수술환자15례,절취식관하괄약기작위대조조표본.채용면역조화염색법,현미경하수궤선취3개시야관찰ICC화유일양화담합매재량조식관하괄약기중적분포화표체정황,계산장간질세포적개수화반정량판정일양화담합매적표체강도.결과 광경하관찰,대조조식관하괄약기중유장간질세포분포,정사형,량단세장돌기,미산분포재기층중,여기속평행주향,부분장간질세포간돌기상호련접,매절편평균계수(11.2±7.4)개.실험조중장간질세포분포희소,세포돌기불명현,매절편평균계수(5.8±5.6)개,여대조조비교차이유통계학의의(P=0.01).식관하괄약기중야가견일양화담합매염색양성신경섬유,대조조염색신경섬유조대,염색심,실험조중신경섬유섬세,염색담,분포희소,량조재염색강도상비교차이야유통계학의의(P=0.13).결론 장간질세포화일양화담합매재분문실이완증환자식관하괄약기중분포화표체이상,량자가능여분문실이완증발병유관.
Objective To investigate the correlationship between the nitric oxide(NO) and interstitial cell of Cajal (ICC) and achalasia (AC) and the pathogenesis of AC.Methods A total of 16 patients with AC who visited endoscopy center of the Zhongshan Hospital from August 2011 to December 2011were enrolled as the experimental group.The specimens of experimental group were obtained by biopsy of lower esophageal sphincter during peroral endoscopic myotomy(POEM) procedure.The 15 lower esophageal sphincter(LES) surgical specimens of non-esophageal motility disorders were enrolled as the control group.All specimens were made into paraffin sections and were examined by immunohistochemical staining method.The distribution of ICC and expression of nitric oxide synthase (NOS) under light microscope were observed.ICC was calculated and the staining intensity of NOS was semi-quantitatively evaluated in selected fields of vision at random.Results Under light microscope,ICC distributed and NOS was expressed in the LES.ICC was fusiform with two elongated apophysis.ICC was linked by apophysis and parallelly distributed with smooth muscle cells.The density of ICC in the experimental group was reduced and apophysis was less obvious compared with that in control group with significant differences(5.8 ±5.6 VS 11.2 ±7.4,P =0.01).Likewise,NOS positive nerve fibers was visible in LES.NOS positive nerve fibers were absent and the strength of staining was weaker in AC group compared with that in control group with significant differences(P =0.13).Conclusion Abnormal distribution of ICC and NOS in LES may be correlated with AC.