Diez-Arias J A, Aller M A, Palma M D, Arias J L, Muñiz E, Sánchez M, Arias J
Cellular Biology I Department, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain.
Dig Surg. 2001;18(1):34-40. doi: 10.1159/000050094.
Enteropathy characterized by vascular and inflammatory alterations in the submucosa and mucosa has been described in patients with portal hypertension.
To verify the theory of inflammatory etiopathogenesis in experimental portal hypertensive duodenopathy, a prehepatic portal hypertension model based on the development of a single and triple partial ligation of the portal vein was used in the rat.
Five rats in each group (male Wistar, 230-255 g) were subjected to single (group II) or triple (group III) partial ligation of the portal vein and then compared to 5 control animals (group I, no operation). The animals were sacrificed 6 weeks later to analyze the histological parameters of the duodenal mucosa and submucosa, i.e., number, diameter and area of submucosal vessels, density of mast cells and mitotic cells. Body, liver and spleen weights and collateral circulation type were also assayed.
As was demonstrated by the collateral circulation in all of the animals, the partial portal ligation was successful. Compared to the controls, the number of vessels per microscopic field (25 +/- 3.16 vs. 18.60 +/- 1.52), their diameter (20.09 +/- 2.90 vs. 12.61 +/- 3.97 microm, p < 0.05) and consequently their total area (12,749.30 +/- 2,298.26 vs. 3,455.82 +/- 1,702.33 microm2) were increased in the animals with a single partial ligation (group II) as well as in animals receiving triple partial ligation (group III) (33 +/- 12.88, p < 0.05; 22.92 +/- 6.72 microm, p < 0.05 and 51,376.95 +/- 43,732.24 miccrom2, p < 0.05, respectively). In addition, the density of mast cells increased from 3.26 +/- 1.18 in controls to 10.74 +/- 1.47, p < 0.01 and 22.50 +/- 6.42, p < 0.01 in single and triple partial portal ligated animals, respectively. Mitosis was significantly induced in crypts of the duodenal mucosa of the single portal ligated animals (25.20 +/- 1.78 vs. 17.40 +/- 1.14, p < 0.01) but was inhibited in triple partial ligated animals (12.40 +/- 5.12, p < 0.05). Compared to controls, both groups of rats developed liver atrophy with a greater decrease in the liver/body weight ratio in the single (2.71 +/- 0.50%, p < 0.01) compared to the triple partial ligated animals (3.33 +/- 0.09%, p < 0.01).
The correlation of the degree of portal hypertension with the vascular changes and mast cell density suggests that both the hypertensive state and inflammation may play a role in the development of portal hypertensive intestinal vasculopathy. The inverse relation of portal hypertension with liver atrophy and mitosis rate in the crypts of the duodenal mucosa has not been clarified and should be investigated in future studies.
门静脉高压患者中已描述了以黏膜下层和黏膜血管及炎症改变为特征的肠病。
为验证实验性门静脉高压性十二指肠病的炎症病因发病理论,在大鼠中采用基于门静脉单次和三次部分结扎发展而来的肝前性门静脉高压模型。
每组5只大鼠(雄性Wistar,体重230 - 255 g)接受门静脉单次(第二组)或三次(第三组)部分结扎,然后与5只对照动物(第一组,未手术)进行比较。6周后处死动物,分析十二指肠黏膜和黏膜下层的组织学参数,即黏膜下血管的数量、直径和面积、肥大细胞密度和有丝分裂细胞。还测定了体重、肝脏和脾脏重量以及侧支循环类型。
所有动物的侧支循环均表明部分门静脉结扎成功。与对照组相比,单次部分结扎动物(第二组)以及接受三次部分结扎的动物(第三组)每高倍视野血管数量(25 ± 3.16对18.60 ± 1.52)、血管直径(20.09 ± 2.90对12.61 ± 3.97微米,p < 0.05)以及因此其总面积(12,749.30 ± 2,298.26对3,455.82 ± 1,702.33平方微米)均增加(分别为33 ± 12.88,p < 0.05;22.92 ± 6.72微米,p < 0.05和51,376.95 ± 43,732.24平方微米,p < 0.05)。此外,肥大细胞密度从对照组的3.26 ± 1.18分别增加到单次和三次部分门静脉结扎动物的10.74 ± 1.47,p < 0.01和22.50 ± 6.42,p < 0.01。单次门静脉结扎动物十二指肠黏膜隐窝中有丝分裂显著诱导(25.20 ± 1.78对17.40 ± 1.14,p < 0.01),但在三次部分结扎动物中受到抑制(12.40 ± 5.12,p < 0.05)。与对照组相比,两组大鼠均出现肝脏萎缩,单次部分结扎动物肝脏/体重比下降幅度更大(分别为2.71 ± 0.50%,p < 0.01),而三次部分结扎动物为(3.33 ± 0.09%,p < 0.01)。
门静脉高压程度与血管变化和肥大细胞密度的相关性表明,高血压状态和炎症可能在门静脉高压性肠血管病的发展中起作用。门静脉高压与肝脏萎缩以及十二指肠黏膜隐窝中有丝分裂率的反比关系尚未阐明,应在未来研究中进行调查。