2型糖尿病性腹泻与肠神经系统病变关系的探讨

山东大学学报(医学版) ›› 2011, Vol. 49 ›› Issue (8): 13-.

2型糖尿病性腹泻与肠神经系统病变关系的探讨

王倩1,张莹1,侯为开1,张莉2,徐华3,王鹏4,于珊1, 刘骞1,黄庆先1

1．山东大学齐鲁医院内分泌科，济南 250012；2.山东省交通医院内科，济南 250031；3.济南市第五医院内科，济南 250022； 4.山东大学齐鲁医院消化内科，济南 250012

收稿日期:2010-01-06 出版日期:2011-08-10 发布日期:2011-08-10
通讯作者: 侯为开(1965- )，男，教授，硕士生导师，主要从事糖尿病及其慢性并发症的研究。 Email：wkhousdu@yahoo.com.cn
作者简介:王倩 (1985- )，女，硕士研究生，主要从事糖尿病及神经并发症的研究。 Email：wangqian-qd@yeah.net

Correlation between type 2 diabetes associated diarrhea and changes of enteric nervous system

WANG Qian1, ZHANG Ying1, HOU Wei-Kai1, ZHANG Li2, XU Hua3, WANG Peng4， YU Shan1, LIU Qian1, HUANG Qing-Xian1

1. Department of Endocrinology，Qilu Hospital of Shandong University, Jinan 250012, China;
2. Department of Internal Medicine, Shandong Jiaotong Hospital, Jinan 250031, China；
3. Department of Internal Medicine， The Fifth Hospital of Jinan， Jinan 250022， China；
4．Department of Gastroenterology， Qilu Hospital of Shandong University, Jinan 250012, China

Received:2010-01-06 Online:2011-08-10 Published:2011-08-10

摘要/Abstract

摘要：

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，并结合神经元标志物(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。

关键词: 糖尿病；腹泻；肠黏膜；超微结构；蛋白基因产物9.5

Abstract:

Objective To investigate the correlation between type 2 diabetes associated diarrhea and changes of enteric nervous system. Methods Fourteen patients with type 2 diabetes who underwent colonoscopy for diarrhea symptoms were chosen as the diabetic diarrhea group, ten non-diabetic patients with normal colons underwent colonoscopy for other reasons were elected as the control group. Intestinal mucosa nerve plexus ultrastructural changes were observed by an electric microscope, and structural changes of bowel nerve plexus were observed by using neuron specific protein gene product 9.5(PGP9.5) immunohistochemical method. Results The colonic mucosa in the diabetic diarrhea group had some changes, such as cavitation of the nerve fiber bundle neuraxial cavity, low density in the cytoplasmic matrix of Schwann cells, and thickening of the membrane of unmyelinated nerve fibers. There was no significant change in the control group. After nerve fibers of the colonic mucosa were marked by PGP9.5， average percentage of the PGP9.5positive area in the epithelium and interstitium of the mucosal plexus in the diabetic diarrhea group was significantly larger than that in the control group ［(4.13±1.12)% vs (2.18±1.01)%，P<0.01］. Conclusion Type 2 diabetes associated diarrhea may be related to ultrastructural changes of mucosa plexus. The decrease of nerve fibers in submucosal plexus may be involved in the process of diarrhea symptoms in type 2 diabetes.

Key words: Diabetes； Diarrhea； Intestinal mucosa； Ultra-structure； Protein gene product 9.5

中图分类号:

R587.2

王倩1,张莹1,侯为开1,张莉2,徐华3,王鹏4,于珊1, 刘骞1,黄庆先1. 2型糖尿病性腹泻与肠神经系统病变关系的探讨[J]. 山东大学学报(医学版), 2011, 49(8): 13-.

WANG Qian1, ZHANG Ying1, HOU Wei-Kai1, ZHANG Li2, XU Hua3, WANG Peng4， YU Shan1, LIU Qian1, HUANG Qing-Xian1. Correlation between type 2 diabetes associated diarrhea and changes of enteric nervous system[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2011, 49(8): 13-.

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