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目的 检测先天性巨结肠症 (HD)、肠神经发育不良 (IND)、肠神经元减少症 (HYPG)等各类肠神经畸形 (NIM)的不同肠段的一氧化氮合酶 (nNOS)、血红素氧合酶 2 (HO 2 )和血管活性肠肽(VIP)的表达与分布 ,探讨它们的表达、分布差异以及对临床的指导意义。方法 使用SP免疫组织化学方法 ,观察 12例HD、15例IND和 3例HYPG患儿的不同肠段中nNOS、HO 2和VIP的分布 ,并将吻合口处直肠肠段与 10例正常儿童结肠对比。结果 HD组中直肠的nNOS和HO 2染色阳性的纤维偶见 ,但VIP在黏膜下层的染色在不同病例中不尽相同 ;IND组直肠和扩张结肠中nNOS和VIP阳性的神经元和神经纤维有不同程度增多 ;HYPG组中直肠三种神经递质表达均有不同程度减少。结论 不同神经递质的表达在各类NIM中并不一致 ,提示HD、IND及HYPG的发病原因不完全相同。检测直肠远端的神经递质 ,特别是nNOS的含量和分布有助于临床鉴别各类NIM。
Objective To detect nitric oxide synthase (nNOS) in different intestine of various types of enteric deformity (NIM) such as Hirschsprung ’s disease (HD), intestinal dysplasia (IND) The expression and distribution of heme oxygenase 2 (HO 2) and vasoactive intestinal peptide (VIP), to explore their expression, distribution and clinical significance. Methods SP immunohistochemistry was used to observe the distribution of nNOS, HO 2 and VIP in different segments of 12 children with HD, 15 with IND and 3 with HYPG. The distribution of nNOS, HO 2 and VIP in the intestine of the anastomosis and 10 normal children Compared. Results The rectal nNOS and HO 2 -positive fibers in the HD group were occasionally seen, but the staining of VIP in the submucosa differed in different cases. The nNOS and VIP-positive neurons and nerve fibers in the rectum and dilated colon of the IND group had Varying degrees of increase; HYPG group rectal neurotransmitter expression were reduced to varying degrees. Conclusion The expression of different neurotransmitters is not consistent in all kinds of NIM, suggesting that the causes of HD, IND and HYPG are not exactly the same. Detection of the distal rectum neurotransmitter, in particular the content and distribution of nNOS contribute to the clinical identification of various types of NIM.