Iantorno Guido, Bassotti Gabrio, Kogan Zulema, Lumi Carlos Miguel, Cabanne Ana Maria, Fisogni Simona, Varrica Liliana Monastra, Bilder Claudio R, Munoz Juan Pablo, Liserre Barbara, Morelli Antonio, Villanacci Vincenzo
Digestive Motility Section, Dr C B Udaondo Hospital, Buenos Aires, Argentina.
Am J Surg Pathol. 2007 Mar;31(3):460-8. doi: 10.1097/01.pas.0000213371.79300.a8.
Chagas disease frequently causes megacolon. We investigated the enteric nervous systems in patients with chagasic megacolon compared to idiopathic megacolon and controls. Surgical specimens were obtained from 12 patients with chagasic megacolon (1 woman, 11 men, age range 41 to 72 y) and 9 patients with idiopathic megacolon (3 women, 6 men, age range 39 to 68 y), undergoing surgery for intractable constipation. A control group of 10 patients (9 women, 1 man, age range 43 to 75 y) undergoing left hemicolectomy for nonobstructing colorectal cancer was also studied. Colonic sections were investigated by conventional and immunohistochemical methods, also taking into consideration the presence of lymphocytes. Compared to controls, the 2 megacolon groups showed a decrease of enteric neurons (not due to increased apoptosis) and of enteric glial cells (all more important in chagasic patients). The interstitial cells of Cajal subtypes were decreased but not absent in megacolons, although an increase of the intramuscular subtype was found, suggesting a possible compensative mechanism. An increased amount of fibrosis was found in the smooth muscle and the myenteric plexus of chagasic patients compared to the idiopathic megacolon and the control group. A mild lymphocytic infiltration of the enteric plexuses (more evident in Chagas disease) was also found in megacolons but not in controls. Patients with chagasic megacolon display important abnormalities of several components of the enteric nervous system. Similar alterations, although of lesser severity, may be found in patients with idiopathic megacolon.
恰加斯病常导致巨结肠。我们对患有恰加斯病性巨结肠的患者的肠神经系统进行了研究，并与特发性巨结肠患者及对照组进行了比较。手术标本取自12例患有恰加斯病性巨结肠的患者（1名女性，11名男性，年龄范围41至72岁）和9例患有特发性巨结肠的患者（3名女性，6名男性，年龄范围39至68岁），这些患者因顽固性便秘接受手术。还研究了一个由10名患者组成的对照组（9名女性，1名男性，年龄范围43至75岁），他们因非梗阻性结直肠癌接受左半结肠切除术。采用传统方法和免疫组织化学方法对结肠切片进行研究，同时考虑淋巴细胞的存在情况。与对照组相比，两个巨结肠组的肠神经元（并非因凋亡增加）和肠神经胶质细胞数量均减少（在恰加斯病患者中更为明显）。尽管发现肌内亚型的 Cajal 间质细胞数量增加，提示可能存在一种代偿机制，但 Cajal 间质细胞亚型在巨结肠中减少但并非缺失。与特发性巨结肠组和对照组相比，恰加斯病患者的平滑肌和肌间神经丛中纤维化程度增加。在巨结肠中还发现肠神经丛有轻度淋巴细胞浸润（在恰加斯病中更明显），而对照组未发现。患有恰加斯病性巨结肠的患者的肠神经系统多个组成部分存在重要异常。特发性巨结肠患者可能也会出现类似改变，尽管程度较轻。
