Shan Yan-Shen, Sy Edgar D, Tung Hui-Ling, Tsai Mei-Ling, Lin Pin-Wen
Department of Surgery, National Cheng Kung University Hospital, Institute of Clinical Medicine, College of Medicine National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1375-82.
BACKGROUND/AIMS: Intrinsic inhibitory enteric neurons are considered to play an important role in the regulation of antropyloroduodenum coordination for gastric emptying. This study is designed to investigate the change of enteric neurons in the pylorus and antrum muscle in PPPD patients who have delayed gastric emptying.
Muscle strips of the pylorus and antrum from 6 normal and 2 PPPD patients with delayed gastric emptying were used for contraction study, immunohistochemical staining for enteric neurons, and western blotting for expression of neuropeptides.
Under the stimulation of carbachol, the contraction profile of the muscle strip from patients who had PPPD was different from those of the normal strips: muscle power of the ED50 of the pylorus/antrum were 1270mg/1400mg in normal strips, 400mg/1000mg in case 1, and 50mg/500mg in case 2. The frequency of muscle contraction was 3 times per minute in the normal strips, but 2.5 and 2 times per minutes in case 1 and case 2. From immunohistochemical staining, the density of inhibitory enteric neurons; nNOS-, CGRP-, and SST-containing nerve fibers and cells of Cajal, were significantly reduced in the pylorus and antrum muscle from the patients having delayed gastric emptying after PPPD. The protein content of inhibitory enteric neuropeptides, nNOS and CGRP, were also significantly decreased.
These results suggest that the early loss of inhibitory enteric neurons in the preserved pylorus and antrum may be correlated with delayed gastric emptying in patients receiving PPPD.
背景/目的：内在抑制性肠神经元被认为在胃排空的胃幽门十二指肠协调调节中起重要作用。本研究旨在调查胃排空延迟的十二指肠溃疡后综合征（PPPD）患者幽门和胃窦肌肉中肠神经元的变化。
使用6例正常人和2例胃排空延迟的PPPD患者的幽门和胃窦肌条进行收缩研究、肠神经元免疫组织化学染色以及神经肽表达的蛋白质印迹分析。
在卡巴胆碱刺激下，PPPD患者的肌条收缩情况与正常肌条不同：正常肌条幽门/胃窦的半数有效剂量（ED50）肌肉力量分别为1270mg/1400mg，病例1为400mg/1000mg，病例2为50mg/500mg。正常肌条的肌肉收缩频率为每分钟3次，而病例1和病例2分别为每分钟2.5次和2次。免疫组织化学染色显示，PPPD后胃排空延迟患者的幽门和胃窦肌肉中，抑制性肠神经元、含nNOS、CGRP和SST的神经纤维以及 Cajal细胞的密度显著降低。抑制性肠神经肽nNOS和CGRP的蛋白质含量也显著下降。
这些结果表明，保留的幽门和胃窦中抑制性肠神经元的早期丧失可能与接受PPPD治疗的患者胃排空延迟有关。
