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目的:从胃黏膜上皮细胞超微结构变化角度研究慢性胃炎(CG)肝胃不和、脾胃气虚及脾胃湿热3种证型胃黏膜上皮细胞病理微观结构特征并探讨其演变规律。方法:32例CG 3种证型患者胃镜下分别在胃窦及胃体部取黏膜活检组织,快速尿素酶试验(RUT)检测幽门螺旋杆菌(Hp),光镜下观察胃黏膜组织病理学变化;透射电镜下观察胃黏膜上皮细胞超微结构变化。结果:胃镜下3种证型伴Hp感染、胆汁返流及黏膜糜烂例数未见统计学差异,脾胃气虚证未见胆汁返流病例。光镜下3种证型胃黏膜均伴Hp感染、黏膜糜烂、腺体萎缩、肠化(IM)和/或不典型增生(ATP),例数未见统计学差异。透射电镜下发现:1CG 3种证型之间、同一证型不同个体之间、同一个体不同胃黏膜上皮细胞之间,细胞微绒毛形态数量、细胞连接、胞浆基质、核及核仁形状大小或/和数量、核膜厚薄、异染色质与常染色质的分布及比例等均不完全相同。2均可见亮暗细胞现象、细胞凋亡、空泡变性、线粒体肿胀、主细胞粗面内质网扩张及溶酶体形成等,但严重程度及/或数量有所差异。肝胃不和证线粒体肿胀相对明显;脾胃气虚证线粒体数量及/或面积减少上皮细胞数量较多;脾胃湿热证凋亡细胞数量较多。3脾胃气虚证和脾胃湿热证局部上皮细胞增宽的间隙内均可见渗出物,前者渗出物较稀薄,后者渗出物浓缩呈团块状。结论:胃黏膜上皮细胞超微结构变化是CG证型及症状不同的病理微观结构基础。
OBJECTIVE: To study the pathological and microscopic features of gastric mucosa epithelial cells in patients with chronic gastritis (CG) from the perspective of ultrastructure changes of gastric mucosa epithelial cells. Methods: Thirty-two patients with CG syndromes underwent gastroscopic examination of mucosa biopsies in the gastric antrum and gastric mucosa respectively. The rapid urease test (RUT) was used to detect H. pylori (Hp). The pathological changes of gastric mucosa were observed under light microscope The ultrastructural changes of gastric mucosal epithelial cells were observed under transmission electron microscope. Results: There were no significant differences among the three types of syndromes accompanied by Hp infection, bile reflux and mucosal erosion under gastroscopy. No cases of bile reflux were found in spleen-qi deficiency syndrome. The three kinds of gastric mucosa under light microscope were associated with Hp infection, mucosal erosions, glandular atrophy, intestinal metaplasia (IM) and / or dysplasia (ATP), with no significant difference in the number of cases. The results of transmission electron microscopy showed that the number of microvilli, the number of cell microvilli, the number of cell junctions, cytoplasmic matrix, nucleus and nucleolus size of ICG among the three kinds of syndromes, between different individuals of the same type and between different gastric epithelial cells of the same individual Or / And the number of nuclear membrane thickness, heterochromatin and euchromatin distribution and proportion are not exactly the same. 2 showed the phenomenon of light and dark cells, apoptosis, vacuolar degeneration, mitochondria swelling, expansion of the main cell endoplasmic reticulum and lysosome formation, but the severity and / or the number of differences. Liver and stomach discordant mitochondria swelling is relatively obvious; stomach qi deficiency mitochondrial number and / or area to reduce the number of epithelial cells more; spleen and stomach Damp heat syndrome more apoptotic cells. 3 spleen qi deficiency syndrome and spleen and stomach heat syndrome local epithelial cells widened gap can be seen within the exudate, exudate former thinner, the latter exudate was concentrated into a mass. Conclusion: The ultrastructural changes of gastric mucosal epithelial cells are the basis of pathological and microscopic structures of CG syndromes and symptoms.