Abel R M, Bishop A E, Dore C J, Spitz L, Polak J M
Department of Histochemistry and the Medical Statistics Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
J Pediatr Surg. 1998 May;33(5):682-7. doi: 10.1016/s0022-3468(98)90187-7.
The aim of this study was to quantify changes in dimensions of nerves and muscle and the proportionate expression of neural antigens in infantile hypertrophic pyloric stenosis (IHPS).
Twenty specimens of pylorus from children with IHPS and age/sex-matched controls were examined using conventional histology and immunohistochemistry for a range of nerve and muscle antigens. The changes in the proportion of nerves expressing each antigen were quantified and statistically analyzed.
The longitudinal muscle was found to be hypertrophic and protein gene product 9.5-stained nerves appeared longer and thicker in the myenteric plexus and shorter in the longitudinal muscle layer in IHPS. The proportion of nerves that expressed neural nitric oxide synthase (nNOS) was found to be diminished in all the IHPS tissues examined. In the circular muscle and myenteric plexus, the proportion of nerves that expressed vasoactive intestinal polypeptide (VIP) and nNOS was almost identically diminished. The expression of calcitonin gene-related polypeptide and substance P was proportionately reduced in the myenteric plexus.
The results of this study represent the first quantitative analysis of nerves and muscle in IHPS. The muscle hypertrophy is not restricted to circular muscle layer. The changes in nerve morphology cannot be attributed to a dilutional effect of the muscle hypertrophy. The selective changes in nerve and ganglion morphology varies between tissue layers and neural antigen expressed. The findings of reduced proportions of nerves expressing, in particular, nNOS may shed some light on the etiology of this condition.
本研究旨在量化婴儿肥厚性幽门狭窄（IHPS）中神经和肌肉维度的变化以及神经抗原的相对表达。
使用传统组织学和免疫组织化学方法，对20例IHPS患儿以及年龄/性别匹配的对照组患儿的幽门标本进行一系列神经和肌肉抗原检测。对表达每种抗原的神经比例变化进行量化并进行统计学分析。
发现IHPS患儿的纵行肌肥厚，蛋白基因产物9.5染色的神经在肌间神经丛中显得更长更粗，而在纵行肌层中则更短。在所检测的所有IHPS组织中，发现表达神经型一氧化氮合酶（nNOS）的神经比例降低。在环行肌和肌间神经丛中，表达血管活性肠肽（VIP）和nNOS的神经比例几乎同样降低。降钙素基因相关肽和P物质的表达在肌间神经丛中相应减少。
本研究结果代表了对IHPS中神经和肌肉的首次定量分析。肌肉肥大并不局限于环行肌层。神经形态的变化不能归因于肌肉肥大的稀释效应。神经和神经节形态的选择性变化在不同组织层和所表达的神经抗原之间有所不同。特别是表达nNOS的神经比例降低的发现可能为这种疾病的病因提供一些线索。
