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目的探讨Graves甲亢患者腹泻的发病机制。方法应用RT-PCR的方法检测Graves甲亢伴腹泻组(GD组)和结肠易激综合征腹泻型组(IBS-D组)患者回肠与结肠组织中TSH-β和TSH受体(TSHR)基因表达;以免疫组化检测回肠和结肠TSHR阳性细胞。结果两组患者肠组织中均有TSH-β和TSHR基因mRNA表达。甲亢组患者结肠组织中TSH-β基因表达量明显低于IBS-D组(分别为0.137±0.012和0.209±0.015,p<0.05);TSHR基因表达量显著高于对照组(分别为0.251±0.017和0.181±0.012,P<0.05);而回肠组织中二种基因表达量与对照组无明显差异。两组患者回肠和结肠组织的间质细胞上均有TSHR阳性颗粒沉积,甲亢组患者的回肠组织中TSHR阳性细胞数与对照组无明显差异,而结肠组织间质细胞中TSHR阳性细胞计数明显多于对照组患者(分别为83±8/高倍视野和56±9/高倍视野,P<0.05)。结论两组患者的回肠和结肠组织中均有TSH-β和TSHR基因的表达,提示Graves甲亢患者的肠道症状可能与TSH-β和TSHR的局部分泌和自身免疫调节有关。
Objective To investigate the pathogenesis of diarrhea in patients with Graves hyperthyroidism. Methods The expressions of TSH-β and TSH receptor (TSHR) genes in ileum and colon of Graves’ hyperthyroidism with diarrhea group (GD group) and IBS diarrhea group (IBS-D group) The ileum and colon TSHR positive cells were detected by immunohistochemistry. Results TSH-β and TSHR gene mRNA expressions were found in both groups. The expression of TSH-β in colon tissue of patients with hyperthyroidism was significantly lower than that of IBS-D (0.137 ± 0.012 and 0.209 ± 0.015, p <0.05), and the expression of TSHR was significantly higher than that of control (0.251 ± 0.017 And 0.181 ± 0.012, P <0.05). However, there was no significant difference in the expression of the two genes in the ileum between the two groups. The TSHR-positive granules were deposited on the interstitial cells of ileum and colon in both groups. The number of TSHR positive cells in ileum of patients in hyperthyroid group was not significantly different from that in control group, while the number of TSHR positive cells in colon stromal cells was significantly higher In the control group (83 ± 8 / high power field and 56 ± 9 / high power field, respectively, P <0.05). Conclusion The expressions of TSH-β and TSHR genes in both ileum and colon tissues of both groups suggest that the intestinal symptoms of Graves hyperthyroidism may be related to the local secretion of TSH-β and TSHR and the regulation of autoimmunity.