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人类肠道神经病变:形态学与分子病理学

Human enteric neuropathies: morphology and molecular pathology.

作者信息

De Giorgio R, Camilleri M

机构信息

Department of Internal Medicine & Gastroenterology, University of Bologna, Bologna, Italy.

出版信息

Neurogastroenterol Motil. 2004 Oct;16(5):515-31. doi: 10.1111/j.1365-2982.2004.00538.x.

Abstract

The aim of this study is to review current understanding of the molecular and morphological pathology of the enteric neuropathies affecting motor function of the human gastrointestinal tract and to evaluate the described pathological entities in the literature to assess whether a new nosology may be proposed. The authors used PUBMED and MEDLINE searches to explore the literature pertinent to the molecular events and pathology of gastrointestinal motility disorders including achalasia, gastroparesis, intestinal pseudo-obstruction, colonic inertia and megacolon in order to characterize the disorders attributable to enteric gut neuropathies. This scholarly review has shown that the pathological features are not readily associated with clinical features, making it difficult for a patient to be classified into any specific category. Individual patients may manifest more than one of the morphological and molecular abnormalities that include: aganglionosis, neuronal intranuclear inclusions and apoptosis, neural degeneration, intestinal neuronal dysplasia, neuronal hyperplasia and ganglioneuromas, mitochondrial dysfunction (syndromic and non-syndromic), inflammatory neuropathies (caused by cellular or humoral immune mechanisms), neurotransmitter diseases and interstitial cell pathology. The pathology of enteric neuropathies requires further study before an effective nosology can be proposed. Carefully studied individual cases and small series provide the basic framework for standardizing the collection and histological evaluation of tissue obtained from such patients. Combined clinical and histopathological studies may facilitate the translation of basic science to the clinical management of patients with enteric neuropathies.

摘要

本研究的目的是回顾目前对影响人类胃肠道运动功能的肠道神经病变的分子和形态病理学的认识,并评估文献中描述的病理实体,以确定是否可以提出一种新的疾病分类法。作者利用PUBMED和MEDLINE检索,探索与胃肠道动力障碍(包括贲门失弛缓症、胃轻瘫、肠道假性梗阻、结肠惰性和巨结肠)的分子事件和病理学相关的文献,以便对肠道神经病变所致的疾病进行特征描述。这项学术综述表明,病理特征与临床特征之间没有明显关联,这使得患者难以被归入任何特定类别。个体患者可能表现出不止一种形态学和分子异常,包括:无神经节症、神经元核内包涵体和凋亡、神经变性、肠道神经元发育异常、神经元增生和神经节神经瘤、线粒体功能障碍(综合征性和非综合征性)、炎症性神经病变(由细胞或体液免疫机制引起)、神经递质疾病和间质细胞病变。在提出有效的疾病分类法之前,肠道神经病变的病理学需要进一步研究。经过仔细研究的个体病例和小系列病例为此类患者组织的收集和组织学评估的标准化提供了基本框架。临床和组织病理学的联合研究可能有助于将基础科学转化为肠道神经病变患者的临床管理。

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