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目的研究非糜烂性胃食管反流病(NERD)患者食管内脏感觉过敏与食管下端括约肌(LES)黏膜中P物质(SP)免疫反应阳性产物表达之间的关系。方法对12例正常人(正常对照组)和31例NERD患者(NERD组)采用Synectics内脏刺激器/电子气压泵测定食管对机械刺激的敏感性;利用食管酸灌注试验检测食管对酸的敏感性;采用免疫组织化学技术观察LES局部组织中SP免疫反应阳性产物的表达。结果NERD患者食管对气囊扩张刺激的初始感知阈值、疼痛阈值较正常对照组明显降低(P<0.01),51.6%的患者对食管机械扩张刺激感觉过敏;NERD患者对酸的敏感性较对照组亦明显增加,58.0%的患者对酸感知过敏。NERD患者感知过敏组LES黏膜中SP阳性纤维的数目和平均光密度(OD)值较正常对照组和感知正常的NERD患者明显增高(P<0.05);NERD患者SP阳性产物的OD值与食管初始感知阈值和最大疼痛阈值均呈直线负相关(分别为r=-0.74和r=-0.82,P<0.01)。结论LES局部黏膜中P物质的过度表达可能参与了食管内脏高敏感性形成的外周敏化机制。
Objective To investigate the relationship between esophageal visceral hyperalgesia and substance P (SP) immunoreactive products in the non-erosive gastroesophageal reflux disease (NERD) patients. Methods The sensitivity of esophagus to mechanical stimulation was measured by Synectics visceral stimulator / electropneumatic pump in 12 normal subjects (control group) and 31 NERD patients (NERD group). The esophageal acid perfusion test was used to detect the sensitivity of esophagus to acid Immunohistochemistry was used to observe the expression of SP immunoreactive products in the local tissues of LES. Results The threshold of initial perception and pain threshold of esophageal dilatation of balloon in NERD patients was significantly lower than that of normal control group (P <0.01). 51.6% of the patients had hypersensitivity to esophageal mechanical dilatation. The sensitivity of NERD patients to acid was also higher than that of the control group Significantly increased, 58.0% of patients with allergic acid perception. The number and average optical density (OD) value of SP-positive fibers in LES mucosa of patients with allergic reaction in NERD group were significantly higher than those in normal control group and normal NERD patients (P <0.05). The OD value of SP positive products in NERD patients was similar to that of esophageal initial Perceived threshold and maximum pain threshold showed a linear negative correlation (r = -0.74 and r = -0.82, respectively, P <0.01). Conclusion The overexpression of substance P in the local mucosa of LES may be involved in the peripheral sensitization mechanism of esophageal visceral hypersensitivity.