【作者】 赵莉；

【导师】 祝金泉；

【作者基本信息】 江西医学院 ， 内科学， 2005， 硕士

【摘要】 目的:研究P 物质(substance P,SP)及其受体(substance P receptor,SPR)在肠易激综合征(irritable bowel syndrome,IBS)发生、发展中的作用,探讨IBS 的发病机理。方法:临床症状符合罗马II 标准的IBS 患者40 名,其中腹泻型组(20例)和便秘型组(20 例),无症状对照者15 名。所有患者结肠镜和病理未发现结肠粘膜有病理性变化,结肠镜检查取乙状结肠处粘膜组织,进行SP免疫组织化学染色分析和SPR mRNA 原位杂交分析;并随机加取其中8 例患者乙状结肠处组织观察结肠粘膜细胞超微结构的改变。统计分析SP 与SPR 在腹泻型和便秘型IBS 患者肠粘膜中的表达情况。结果:①结肠粘膜层SP 的表达:SP 的表达主要位于结肠粘膜上皮细胞、肠腺体细胞,粘膜固有层的肥大细胞、中性粒细胞、淋巴细胞及SP 免疫阳性纤维等处。腹泻型IBS 组、便秘型IBS 组及对照组患者SP 的表达强度差异有非常显著意义(P<0.01);两两比较,腹泻型IBS 组SP 的表达显著高于对照组,差异有显著意义(P<0.017),而便秘型IBS 患者SP 表达与对照组间差别无统计学意义(P>0.05),但粘膜固有层的肥大细胞、中性粒细胞、淋巴细胞及SP 免疫阳性纤维等处的表达明显高于粘膜上皮细胞及腺体细胞表达,差异有非常显著意义(P<0.017);腹泻型IBS 组SP 表达显著强于便秘型IBS 组(P<0.017)。便秘型IBS 组结肠粘膜结缔组织SP 表达显著强于上皮细胞和腺细胞(P<0.017)。②结肠粘膜SPR mRNA 表达情况:腹泻型IBS 组、便秘型IBS 组及对照组SPR mRNA 的表达差异有非常显著意义(P<0.01);两两比较,在腹泻型IBS 组表达明显强于对照组及便秘型IBS 组(P<0.017),而便秘型IBS 组表达显著弱于对照组(P<0.017)。③电镜观察发现腹泻型IBS 患者结肠粘膜上皮细胞膜完整,细胞形态无异常,粘膜中杯状细胞、浆细胞、肥大细胞和神经内泌细胞的超微结构均可见大量的分泌颗粒、空泡、粗面内质网等,呈现功能活跃和分泌旺盛状态。更多还原

【Abstract】 Objectives: To Study function of substance P(SP) and substance Preceptor(SPR) in the occurrence and the development of irritable bowelsyndrome(IBS), and to explore the pathogenesis of IBS.Methods: TO get 40 patients with clinical symptom accords withRomeII standard of IBS, among them comprised the suffering fromdiarrhoea type group (20) and constipated group (20) and to get 15persons who didn’t have symptom as contrast group. All patients werenot found pathology changes of colon mucous membranes by colonoscopyand pathology. Sigmoid colons mucous membranes fetched by colonscopewere prepared for SP immunocytochemistry and SPR mRNA in situhybridization(ISH) and for the ultrastrucure of colon mucosa byelectron microscope (8 subjects among them). The expression levels ofSP and SPR were analyzed.Results:①Expressions of SP in colon mucous membranes:Expressionsof SP mainly lay in epithelias, intestines gland cells, lymphocytes,mast cells, neutral cells and fibre tissues of colon mucous membranes.The differences of expression intensity of SP were significant amongdiarrhea-predominant IBS(D-IBS) group, constipated-predominantIBS(C-IBS) group and contrast group(P<0.01). The expressions of SPwere compared between group and group, and results showed thatexpressions of SP in group of D-IBS were higher than contrast groupmarkedly(P<0.017), but no significances were found in the group ofC-IBS(P>0.05).The expressions of SP in lymphocytes、mast cells、neutral cells and fibre tissues of layer of mucous membranes werehigher than in colon epithelias, intestines gland cells markedly(P<0.017). In group of D-IBS expressions of SP were higher than C-IBSgroup(P<0.017). The expressions of SP in connective tissues werehigher than that of colon epithelias and intestines gland cells(P<0.017).②Expressions of SPR mRNA in colon mucous membranes: Thedifferences of expression intensity of SPR mRNA were significant amongD-IBS group, C-IBS group and contrast group(P<0.01). To compareexpressions of SP between group and group, results showed that in groupof D-IBS expressions of SPR mRNA were higher than contrast group andC-IBS group markedly(P<0.017), while C-IBS group’s expressions of SPRmRNA were weaker than contrast group(P<0.017). ③To observe thecolonic mucosa of patients with IBS by Scanning electron microscope,results showed the integrity of epithelium cells’ membranes, normalcell shapes. Large of secretive granules, vacuoles, rough endoplasmicreticulums et al were observed in goblet cells, plasmocytes,mastocytes and neuroendocrine cells. Results presented that active offunction and secreting of these cells were stronger than contrastgroup. Conclusions: 1. Expressions of SP/SPR are obviously increased in colon mucousmembranes of D-IBS group. This may reflect that the high expressionsof SP/SPR solve one of the reasons why the patients to suffer fromabdominal pain, the number of times of stool increases and the mucusstool. 2. C-IBS patients are mainly because lower expressions of SPR ofcolon mucous membranes, to make the intestines in the state ofsuppressed, thus wriggle to slow down to cause the great constipationto form.3. Except abnormal changes of part microvilli and desmosomes, allother organelles of epithelium cells in IBS have no obvious regularchanges. The ultrastrucure of mastocytes, plasmocytes, neuroendocrinecells and goblet cells indicate that those cells may play role onpathogenesis of IBS. The hyperfunction state of this kind of functionmay suggest having something to do with high expressions of SP and SPRwith suffering from D-IBS patients.更多还原