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目的探讨2型糖尿病患者腹泻与肠神经系统病变的关系。方法选取因2型糖尿病性腹泻而行结肠镜检查的患者14例为糖尿病腹泻组,以其他原因进行结肠镜检查而结肠正常的非糖尿病患者10例为对照组。电镜下观察肠黏膜神经丛超微结构的变化,并结合蛋白基因产物9.5(PGP9.5)的免疫组织化学染色方法,观察肠神经丛形态、结构改变。结果电镜检查显示,糖尿病腹泻组结肠黏膜层神经纤维束轴索腔空化、雪旺细胞胞质基质呈低电子密度、无髓神经纤维外基膜增厚等改变;对照组则无明显改变。应用PGP9.5标记结肠黏膜层神经纤维后,糖尿病组肠黏膜PGP9.5阳性面积占上皮间质总面积的平均百分比显著高于对照组[(4.13±1.12)%vs(2.18±1.01)%,P<0.01)]。结论 2型糖尿病腹泻可能与肠黏膜神经丛超微结构的变化有关;肠黏膜神经丛内肠神经纤维数量的改变可能参与了2型糖尿病患者腹泻症状的产生过程。
Objective To investigate the relationship between diarrhea and enteric nervous system in type 2 diabetic patients. Methods Forty patients with type 2 diabetic diarrhea who underwent colonoscopy were selected as diabetic diarrhea patients. Colonoscopy was performed for other reasons and 10 normal non-diabetic patients with normal colon were selected as control group. The ultrastructure of intestinal mucosa plexus was observed under electron microscope. The morphology and structure of intestinal plexus were observed by immunohistochemical staining of protein gene product 9.5 (PGP9.5). Results Electron microscopy showed that cavitation of the axillary cavities of colonic mucosa in diabetic diarrhea group was changed to cavitation of Schwann cells, cytoplasm of Schwann cells with low electron density, thickening of basilar membrane without myelinated nerve fibers, and no significant change in control group. The average percentage of PGP9.5 positive area to the total area of epithelial mesenchyma in diabetic group was significantly higher than that of control group [(4.13 ± 1.12)% vs (2.18 ± 1.01%], PGP9.5-labeled colonic mucosal nerve fibers P <0.01)]. Conclusions Type 2 diabetes mellitus may be related to the ultrastructural changes of intestinal mucosa plexus. The changes of intestinal mucosal plexus nerve fibers may be involved in the development of diarrhea in type 2 diabetic patients.