Xiong S, Puri P, Nemeth L, O'Briain D S, Reen D J
Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland.
Arch Pathol Lab Med. 2000 Oct;124(10):1429-33. doi: 10.5858/2000-124-1429-NHIAA.
The pathogenesis of appendicitis remains poorly understood. However, there is increasing evidence of involvement of the enteric nervous system in immune regulation and in inflammatory responses. This study was set up to characterize the status of the enteric nervous system in normal and in inflamed appendixes.
S100- and 2',2'-cyclic nucleotide 3' phosphodiesterase-positive Schwann cells, synaptophysin, and neuron-specific, enolase-positive nerve fibers and tryptase-positive mast cells were evaluated with immunohistochemical staining in surgically resected appendixes from 20 children with histologically proven acute appendicitis (HA), 10 histologically normal appendixes (HN) from patients with a clinical diagnosis of appendicitis, and 10 normal appendixes from patients undergoing elective abdominal surgery. Immunostained sections were subjected to quantitative image analysis. The number and size of ganglia and the number of nerve fibers, Schwann cells, and mast cells in each tissue compartment was quantitatively or semiquantitatively measured.
Increased numbers of fibers, Schwann cells, and enlarged ganglia, widely distributed in the muscularis externa and submucosa, were seen in all HA appendixes and in 4 of 10 HN appendixes. The number and size of ganglia in muscularis externa and in the submucosa of appendixes with HA were significantly greater compared with those in control appendixes (P <.001). A significantly increased number of individually stained nerve fibers and Schwann cells (P <.05) were present in the muscularis externa in HA appendixes compared with control appendixes. Significantly increased numbers of tryptase-positive mast cells (P <.05) were present in the submucosa, muscularis, and especially in the lamina propria in HA specimens, compared with that of control tissue.
The significant increase in neural components and mast cells in acute appendicitis is unlikely to develop during a single acute inflammatory episode. This suggests an underlying chronic abnormality as a secondary reaction to repeated bouts of inflammation, obstruction, or both. These results challenge our current understanding of the pathophysiological processes that give rise to acute appendicitis.
阑尾炎的发病机制仍未完全明确。然而，越来越多的证据表明肠神经系统参与免疫调节和炎症反应。本研究旨在描述正常阑尾和发炎阑尾中肠神经系统的状态。
对20例经组织学证实为急性阑尾炎（HA）的儿童手术切除阑尾、10例临床诊断为阑尾炎但组织学正常的阑尾（HN）以及10例接受择期腹部手术患者的正常阑尾进行免疫组织化学染色，评估S100和2',2'-环核苷酸3'磷酸二酯酶阳性的施万细胞、突触素、神经元特异性烯醇化酶阳性神经纤维和色氨酸酶阳性肥大细胞。对免疫染色切片进行定量图像分析。定量或半定量测量每个组织区域中神经节的数量和大小以及神经纤维、施万细胞和肥大细胞的数量。
在所有HA阑尾以及10例HN阑尾中的4例中，可见纤维、施万细胞数量增加，神经节增大，广泛分布于肌层和黏膜下层。与对照阑尾相比，HA阑尾肌层和黏膜下层神经节的数量和大小显著增加（P<.001）。与对照阑尾相比，HA阑尾肌层中单独染色的神经纤维和施万细胞数量显著增加（P<.05）。与对照组织相比，HA标本黏膜下层、肌层尤其是固有层中色氨酸酶阳性肥大细胞数量显著增加（P<.05）。
急性阑尾炎中神经成分和肥大细胞的显著增加不太可能在单一急性炎症发作期间出现。这表明存在潜在的慢性异常，是对反复炎症、梗阻或两者兼有的继发反应。这些结果挑战了我们目前对引起急性阑尾炎的病理生理过程的理解。
