Porter A J, Wattchow D A, Hunter A, Costa M
Department of Surgery, Flinders Medical Centre, Adelaide, Australia.
Int J Colorectal Dis. 1998;13(5-6):208-16. doi: 10.1007/s003840050163.
Abnormalities of the enteric nervous system are thought to explain the pathophysiology of motility disorders. Our aim was to determine if particular classes of enteric neurons are affected in slow transit constipation (STC). Specimens were taken from the terminal ileum and ascending, transverse and descending colon of patients undergoing subtotal colectomy for STC. Immunohistochemistry was performed using antisera to neuron-specific enolase, tachykinin, leu-enkephalin, choline acetyltransferase, vasoactive intestinal peptide, nitric oxide synthase, tyrosine hydroxylase and neuropeptide Y. The density of nerve fibres labelled with these antibodies in each layer was compared with age-matched controls. The density of nerve fibres with tachykinin and enkephalin immunoreactivity was reduced in the colonic circular muscle of the 15 patients with STC, whereas innervation of all other layers was normal. This reduction of tachykinin-immunoreactive nerve fibres also occurred in nine of the 12 specimens of terminal ileum examined. No difference was detected in the density or distribution of nerve fibres using the other antisera. Excitatory nerve fibres are present in the circular muscle in STC but they are deficient in tachykinins and enkephalin.
肠神经系统异常被认为可解释动力障碍的病理生理学机制。我们的目的是确定在慢传输型便秘（STC）中特定类型的肠神经元是否受到影响。标本取自因STC接受次全结肠切除术患者的回肠末端、升结肠、横结肠和降结肠。使用针对神经元特异性烯醇化酶、速激肽、亮脑啡肽、胆碱乙酰转移酶、血管活性肠肽、一氧化氮合酶、酪氨酸羟化酶和神经肽Y的抗血清进行免疫组织化学检测。将每层中用这些抗体标记的神经纤维密度与年龄匹配的对照组进行比较。15例STC患者结肠环肌中具有速激肽和脑啡肽免疫反应性的神经纤维密度降低，而所有其他层的神经支配正常。在所检查的12例回肠末端标本中的9例中也出现了速激肽免疫反应性神经纤维的减少。使用其他抗血清未检测到神经纤维密度或分布的差异。STC患者的环肌中存在兴奋性神经纤维，但它们缺乏速激肽和脑啡肽。
