摘要目的 观察贲门失弛缓症(AC)患者食管不同部位肌层的组织学特征,探讨嗜酸性粒细胞在AC患者食管肌层中的分布和作用.方法 纳入2015年6月至2016年2月就诊并经胃镜、钡餐造影和食管高分辨率测压检查确诊,并接受经口内镜下肌切开术治疗的21例AC患者,同时选取行外科食管切除术的9例食管癌患者作为对照.AC患者和食管癌组均分别取食管下括约肌(LES)、食管远段(LES上方5 cm)和食管中段(LES上方10 cm)的环形肌组织各1～2块,常规H-E染色观察并分析两组食管各段肌层组织嗜酸性粒细胞的浸润程度.统计学方法采用非参数检验和卡方检验等,相关性分析采用Spearman相关分析.结果 H-E染色结果显示,18例(85.7 ％)AC患者有不同程度的嗜酸性粒细胞浸润,5例(23.8 ％)AC患者食管肌层每个高倍视野下可见15个以上嗜酸性粒细胞;食管癌组均未见明显嗜酸性粒细胞浸润.AC组LES、食管远段和食管中段胍层嗜酸性粒细胞的中位计数均高于食管癌组[分别为4.0个(2.0个,10.0个)比1.0个(0个,1.5个),4.0个(1.0个,17.0个)比1.0个(0.5个,1.5个),6.0个(0.5个,15.0个)比0个(0个,1.0个)],差异均有统计学意义(Z=2.997、2.476、2.504,P均＜0.05).AC组和食管癌组LES、食管远段和食管中段肌层嗜酸性粒细胞的分布差异均有统计学意义(x2 =2.710、2.543、2.313,P均＜0.05).AC患者LES、食管远段、食管中段肌层嗜酸性粒细胞分布差异无统计学意义(x2 =0.110,P＞0.05).AC患者不同部位食管肌层嗜酸性粒细胞计数与年龄、病程均无相关性(r=0.434、0.639,P=0.282、0.088).结论 AC患者食管肌层广泛分布嗜酸性粒细胞,可能参与了AC的发病过程.

abstractsObjective To observe the histological features of muscular layers in different parts of esophagus of patients with achalasia (AC) and to explore the distribution and function of eosinophils in esophageal muscular layer in patients with AC.Methods From June 2015 to February 2016,21 patients diagnosed with AC by endoscopy,barium meal and esophageal high resolution manometry,accepted peroral endoscopic myotomy (POEM) were enrolled.At the same period,nine patients with esophageal carcinoma who received esophagectomy were selected as controls.Muscular tissues of lower esophageal sphincter (LES),distal esophagus (5 cm above LES) and middle esophagus (10 cm above LES) of patients with AC and controls were taken for regular haematoxylin-eosin (H-E) staining to analyze degree of eosinophils infiltration.Nonparametric analysis and Chi-square analysis were used for statistical analysis.Spearman correlation analysis was used for analyzing correlations.Results The results of H-E staining indicated that different degree of eosinophil infiltration was found in 18(85.7％) patients with AC,and eosinophil counts in muscular layer were over 15 per high power field in five patients with AC (23.8％,5/21).However,no eosinophils infiltration was found in esophageal carcinoma patients.Median numbers of eosinophil in muscular layer of LES,distal esophagus and middle esophagus were all higher than those of esophageal carcinoma group (4.0,2.0 to 10.0 vs 1.0,0 to 1.5;4.0,1.0 to 17.0 vs 1.0,0.5 to 1.5；6.0,0.5 to 15.0 vs 0,0 to 1.0),and the differences were statistically significant (Z=2.997,2.476 and 2.504,all P＜0.05).The distribution of eosinophils in muscular layer of LES,distalesophagus and middle esophagus between the two groups were statistically significant (x2=2.710,2.543and 2.313,all P＜0.05).The differences in eosinophils distribution in muscular layer of LES,distal esophagus and middle esophagus in patients with AC were not ststistically significant (x2 =0.110,P＞0.05).Additionally,number of eosinophils in muscular layer of different parts of esophagus was not correlated with age and disease course (r=0.434 and 0.639；P =0.282 and 0.088).Conclusion The wide distribution of eosinophils in muscular layer of esophagus in patients with AC may involve in the genesis and development of AC.