Zani-Ruttenstock Elke, Zani Augusto, Paul Anu, Diaz-Cano Salvador, Ade-Ajayi Niyi
Department of Paediatric Surgery, King's College Hospital, London, UK.
Department of Paediatric Surgery, King's College Hospital, London, UK.
J Pediatr Surg. 2015 May;50(5):750-4. doi: 10.1016/j.jpedsurg.2015.02.029. Epub 2015 Feb 20.
Gastroschisis associated intestinal dysmotility (GAID) is poorly understood. Animal experiments suggest that interstitial cells of Cajal (ICC), play an important role.
Infants with gastroschisis (GS) and GAID (time to full feed >42days) were selected. Age matched GS and control (NEC, ileal atresia, malrotation, and volvulus) samples from primary (T1) and secondary (T2) time points underwent standard histopathology and immunohistochemistry for identification of ICC, followed by evaluation of ICC numbers, distribution, morphology, relation to ganglion cells, and myenteric plexus architecture. Groups were compared using parametric and nonparametric tests.
Twelve patients had samples available for histopathological evaluation. GAID patients had a significantly lower total number of ICCs than controls (3 vs. 8, P<0.0029). ICC number at T1 was 2.5 vs. 6 (P=0.0629) and significantly lower at T2. (3.5 vs. 11, P=0.0124). GAID patients did not show a significant increase of ICC from T1 to T2. Controls showed a significant increase of ICC over time (6 vs. 11, P=0.0408).
Intestinal samples from infants with GAID who underwent stoma formation demonstrated fewer ICC than controls. There was no improvement or cell recovery during the study period. The ability to modulate ICC may have significant implications for the management of GAID.
胃裂相关肠道运动障碍(GAID)的发病机制尚不清楚。动物实验表明,Cajal间质细胞(ICC)发挥着重要作用。
选取患有胃裂(GS)和GAID(完全经口喂养时间>42天)的婴儿。从原发性(T1)和继发性(T2)时间点采集年龄匹配的GS及对照(坏死性小肠结肠炎、回肠闭锁、肠旋转不良和肠扭转)样本,进行标准组织病理学和免疫组织化学检查以鉴定ICC,随后评估ICC数量、分布、形态、与神经节细胞的关系以及肌间神经丛结构。采用参数检验和非参数检验对各组进行比较。
12例患者的样本可用于组织病理学评估。GAID患者的ICC总数显著低于对照组(3个对8个,P<0.0029)。T1时ICC数量为2.5个对6个(P=0.0629),T2时显著更低(3.5个对11个,P=0.0124)。GAID患者从T1到T2的ICC数量未显著增加。对照组的ICC数量随时间显著增加(6个对11个,P=0.0408)。
接受造口术的GAID婴儿的肠道样本显示ICC数量少于对照组。在研究期间未出现改善或细胞恢复。调节ICC的能力可能对GAID的治疗具有重要意义。