Schmidt H, Riemann J F, Schmid A, Sailer D
Klin Wochenschr. 1984 May 2;62(9):399-405. doi: 10.1007/BF01742296.
Gastrointestinal motility disorders induced by diabetes mellitus are most commonly manifested in the colon, and are considered to be an expression of diabetic autonomic polyneuropathy. In this study, for the first time, the intrinsic nervous system of the bowel has been subjected to an ultrastructural and morphometric examination in rectal biopsy material obtained from diabetics with and without diabetic enteropathy. In patients with diabetic enteropathy, the nerves of the submucous plexus (Meissner's plexus) revealed significant swelling of the axons, as an expression of neural degeneration. Furthermore, in about a half of these patients, thickening of the basal membrane of Schwann's cells was also detected. Additional, although unspecific, changes found in the diabetics were a quantitative increase in the lysosomes, lipofuscin and glycogen in the Schwann cells. The ultrastructural findings represent evidence for the presence of an intrinsic autonomic polyneuropathy in diabetics with diabetic enteropathy. At the same time, they indicate that the diagnosis of diabetic enteropathy is no longer merely an "exclusion" diagnosis.
糖尿病引起的胃肠动力障碍最常见于结肠，被认为是糖尿病自主神经多神经病的一种表现。在本研究中，首次对患有和未患有糖尿病性肠病的糖尿病患者直肠活检材料中的肠道内在神经系统进行了超微结构和形态测量检查。在患有糖尿病性肠病的患者中，黏膜下神经丛（迈斯纳神经丛）的神经显示轴突明显肿胀，这是神经变性的一种表现。此外，在大约一半的这些患者中，还检测到施万细胞基底膜增厚。另外，在糖尿病患者中发现的虽然非特异性但额外的变化是施万细胞中溶酶体、脂褐素和糖原的数量增加。这些超微结构发现为患有糖尿病性肠病的糖尿病患者存在内在自主神经多神经病提供了证据。同时，它们表明糖尿病性肠病的诊断不再仅仅是一种“排除性”诊断。
