目的:通过光镜及电镜观察感染后肠易激综合征(irritable bowel syndrome,IBS)患者结肠黏膜细胞超微结构的变化,探讨其在肠黏膜屏障功能障碍中的可能作用和临床意义.方法:经结肠镜钳取30例感染后IBS患者和10名健康者的乙状结肠黏膜标木,采用石蜡连续切片及原位包埋法,透射电镜观察肥大细胞的形态变化及其相邻组织结构,并应用病理图像分析软件进行分析.结果:感染后IBS患者电镜下可见结肠黏膜上皮细胞膜完整,膜与膜之间桥粒样结构连接,细胞间隙增宽,肠黏膜微绒毛分布尚规整,但密度不均,长短不一,多处微绒毛断裂,粗面内质网发达,在黏膜固有层中见较多肥大细胞,其内可见大量高密度内分泌颗粒,伴有脱颗粒后的空洞,呈现功能活跃和分泌旺盛状态.结论:感染后IBS患者结肠黏膜细胞超微结构发生改变,对肠黏膜屏障功能障碍的发生具有重要影响.%Objective: To investigate the changes of cell ultrastructure in colic mucosa in post infectious irritable bowel syndrome (IBS) through light microscopy and electron microscopy, and to elucidate their possible roles and clinical significance in intestinal mucosal barrier dysfunction. Methods: In 10 normal controls and 30 patients with post-infective IBS, biopsies were taken from the sigmoid colon. The ultrastructure of cells in colic mucosa and the changes of the mast cells in the paraffin-embedded sections were studied through transmission electron microscopy and analyzed by pathological image software. Results:The colic mucosa showed the integrity of epithelial cell membrane, normal cell shape, the regular distribution of microvilli of different length, developed rough endoplasmic reticulum. Many pieces of microvilli had broken. The aperture between cells were remarkably spacious. A large number of secretory granules, vacuoles were seen in the cytoplasm of goblet cells, mast cells and neuroendocrine cells. Conclusions: There were obvious changes on ultrastructure of cells in colic mucosa, which means IBS may be a gastrointestinal organic disease with ultrastrure alterations in colonic mucosa. The changes play a very important role in intestinal mucosal barrier dysfunction.
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