手汗症患者胸交感神经节ChAT、VIP和突触素的表达及意义
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摘要
目的研究手汗症患者胸交感神经节ChAT、VIP和突触素的表达与手汗症的关系。
方法胸腔镜下胸交感神经切除术中获取17例手汗症患者胸交感神经节,并将全胸膜剥脱术中切除的15例非手汗症患者胸交感神经节作为对照。(1)取标本的小部分经甲醛固定,石蜡包埋后备用,剩余的大部分标本经匀浆后应用比色法测定胸交感神经ChAT的活力。(2)石蜡包埋的标本行病理切片后应用免疫组织化学方法检测其VIP和突触素的表达;
结果(1)手汗症患者胸3、4交感神经节ChAT活力比非手汗症患者高(P<0.01),手汗症患者胸3交感神经节ChAT活力高于胸4交感神经节(P<0.01),非手汗症患者胸3、4交感神经节ChAT活力无明显统计学差异(P>0.05)。(2)手汗症患者胸3、4交感神经节VIP的表达水平比非手汗症患者高(胸3比较:P<0.005,胸4比较P<0.05)。(3)手汗症患者胸3、4交感神经节突触素的表达水平比非手汗症患者高(胸3比较:P<0.005,胸4比较P<0.01)。
结论胸交感神经节兴奋性增高可能为手汗症的发病基础之一,切断胸3交感神经节可有效治疗手汗症。
Objective To study the expression of Choline acetyltransferase、Vasoactive intestinal peptide and Synaptophysin of thoracic sympathetic ganglia in the palmar hyperhidrosis patients.
Methods 17 sympathetic ganglia samples of hyperhidrosis patients were obtained during thoracoscopic sympathectomy and 15 samples of normal contrast were obtained during pleurmectomy. (1) Routine resin-embeded specimens were made and then immunohistochemical staining was used to determine the expression of AchR, and synaptophysin in T3﹑ T4 sympathetic ganglia. (2) The rest of sample were homogenated, and the activity of ChAT were determined by colourimetry method, which were also in T3﹑ T4 sympathetic ganglia.
Results (1) Compared with normal contrast, The ChAT expression of T3﹑ T4 sympathetic ganglion in hyperhidrosis cases were significantly increased (P<0.01). The ChAT expression of T3 sympathetic ganglion in hyperhidrosis was higher than The ChAT expression of T4 sympathetic ganglion in hyperhidrosis(P<0.01). The ChAT expression of T3 sympathetic ganglion and T4 sympathetic ganglion in normal contrast was not significantly different (P>0.05). (2)The VIP expression of T3 and T4 ganglion sympathetic ganglion significantly increase as compare to control group (in T3 ganglion, P<0.05;in T4 ganglion, P<0.05). (3) The Synaptophysin expression of T3 and T4 ganglion sympathetic ganglion also significantly increase as compare to control group (in T3 ganglion, P<0.05;in T4 ganglion, P<0.05).
Conclusion The elevated excitability of thoracic sympathetic ganglia is probably the developing mechanism of palmar hyperhidrosis, and sympathectomy of the T3 ganglia can treat palmar hyperhidrosis effectively.
方法胸腔镜下胸交感神经切除术中获取17例手汗症患者胸交感神经节,并将全胸膜剥脱术中切除的15例非手汗症患者胸交感神经节作为对照。(1)取标本的小部分经甲醛固定,石蜡包埋后备用,剩余的大部分标本经匀浆后应用比色法测定胸交感神经ChAT的活力。(2)石蜡包埋的标本行病理切片后应用免疫组织化学方法检测其VIP和突触素的表达;
结果(1)手汗症患者胸3、4交感神经节ChAT活力比非手汗症患者高(P<0.01),手汗症患者胸3交感神经节ChAT活力高于胸4交感神经节(P<0.01),非手汗症患者胸3、4交感神经节ChAT活力无明显统计学差异(P>0.05)。(2)手汗症患者胸3、4交感神经节VIP的表达水平比非手汗症患者高(胸3比较:P<0.005,胸4比较P<0.05)。(3)手汗症患者胸3、4交感神经节突触素的表达水平比非手汗症患者高(胸3比较:P<0.005,胸4比较P<0.01)。
结论胸交感神经节兴奋性增高可能为手汗症的发病基础之一,切断胸3交感神经节可有效治疗手汗症。
Objective To study the expression of Choline acetyltransferase、Vasoactive intestinal peptide and Synaptophysin of thoracic sympathetic ganglia in the palmar hyperhidrosis patients.
Methods 17 sympathetic ganglia samples of hyperhidrosis patients were obtained during thoracoscopic sympathectomy and 15 samples of normal contrast were obtained during pleurmectomy. (1) Routine resin-embeded specimens were made and then immunohistochemical staining was used to determine the expression of AchR, and synaptophysin in T3﹑ T4 sympathetic ganglia. (2) The rest of sample were homogenated, and the activity of ChAT were determined by colourimetry method, which were also in T3﹑ T4 sympathetic ganglia.
Results (1) Compared with normal contrast, The ChAT expression of T3﹑ T4 sympathetic ganglion in hyperhidrosis cases were significantly increased (P<0.01). The ChAT expression of T3 sympathetic ganglion in hyperhidrosis was higher than The ChAT expression of T4 sympathetic ganglion in hyperhidrosis(P<0.01). The ChAT expression of T3 sympathetic ganglion and T4 sympathetic ganglion in normal contrast was not significantly different (P>0.05). (2)The VIP expression of T3 and T4 ganglion sympathetic ganglion significantly increase as compare to control group (in T3 ganglion, P<0.05;in T4 ganglion, P<0.05). (3) The Synaptophysin expression of T3 and T4 ganglion sympathetic ganglion also significantly increase as compare to control group (in T3 ganglion, P<0.05;in T4 ganglion, P<0.05).
Conclusion The elevated excitability of thoracic sympathetic ganglia is probably the developing mechanism of palmar hyperhidrosis, and sympathectomy of the T3 ganglia can treat palmar hyperhidrosis effectively.
引文
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3. Tabet JM, Bay JW, Magdincc MC. Essential hyperhidrosis, Current therapy. Cleveland Clin Q, 1991; 36:79-83.
4. Borak J, Eller JJ, Eller WD(1949) Roentgen therapy for hyperhidrosis . Arch Dermatol Syphil ,1992,59:644-652.
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2. Conlon KC, Kcavery TV. Upper dorsal sympathectomy for hyperhidrosis. Br J surg, 1998; 74:651-654.
3. Tabet JM, Bay JW, Magdincc MC. Essential hyperhidrosis, Current therapy. Cleveland Clin Q, 1991; 36:79-83.
4. Borak J, Eller JJ, Eller WD(1949) Roentgen therapy for hyperhidrosis . Arch Dermatol Syphil ,1992,59:644-652.
5. Stutton DR, Kowalski JW, Glaser DA, et al. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis:Results from a national survey. J Am Acad Dermatol ,2004,51:241-8.
6. Adar R, Kurchin A, Zweig A, et al. Palmar hyperhidrosis and its surgical treatment . A report of 100 cases. Dermatol Surg ,1993,186:34-41.
7. 涂远荣,李旭,林敏等.福州市大中学生手汗症患病情况及相关因素调查.福建医科大学学报.2005,39:128-129.
8. Tolman LP. Treatment of hyperhidrosis . Dermatol Clin ,1998,16:863-7.
9. Kotzareff A. Resection partielle du trone sympathetique cervical droit pour hyperhidrose unilaterale. Rev Med Suisse Romande. 1920 ;40 :111 – 113.
10. Landreneau RJ, Mack MJ, Hazelrigg SR, et al. Video - assisted thoracic surgery: basic technical concepts and intercostal approach strategies. Ann Thorac Surg 1992 Oct ;54(4) :800 – 807.
11. Loscertales J, Arroyo TA, Congregado LM, et al. Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: Immediate Results and Postoperative Quality of Life.Arch Bronconeumol , 2004;40:67-71.
12. Yoon do H, Ha Y, Park YG, et a1.Thoracoscopic limited T-3 sympathicotomy for primary hyperhidrosis : prevention for compensatory hyperhidrosis . J Neurosurg,2003;99:39-43.
13. Neumayer C, Zacherl J, Holak G, et al. Limited endoscopic thoracic sympatheticblock for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4. Surg Endosc. 2004,18:152-6.
14. 刘彦国,石献忠,于恩华,等.上胸段交感神经链切断手术的应用解剖研究.中华胸心血管外科杂志,2005,21:75-77.
15. Wenzel FG, Horn TD. Nonneoplastic disorders of the eccrine glands.J Am Acad Dermatol 1998;38:1-17.
16. Lin TS, Fang HY. Transthoracic endoscopic sympathectomy in the treatment of hyperhidrosis—with emphasis on perioperative management (1360 case analyses). Surg Neurol 1999;52:453-7.
17. 涂远荣, 李旭, 林敏, 等. 手汗症患者胸交感神经超微结构观察. 中华实验外科杂志, 2006, 73:884.
18. 涂远荣, 叶建刚, 李旭, 等. 手汗症患者胸交感神经节乙酰胆碱受体α7 亚单位的表达与临床意义. 中华实验外科杂志, 2006, 23(11):1406-1407.
19. 涂远荣, 李旭, 林敏, 等. 肱动脉血流动力学和掌温检测在胸交感神经干切断术中的临床意义. 中华胸心外科杂志, 2006, Vol.22, No.6:369-370.
20. Chung HI , Oh CS , Koh KS , et al . Anatomic variations of the T2 nerve rootnerve of Kuntz) and their implications for sympathectomy. J Thorac Cardiovasc Surg , 2002 ,123 :498 - 501.
21. 涂远荣,李旭,林敏,等. 胸腔镜下胸交感神经干切断术治疗手掌、腋窝和足底多汗症. 中国基层医药,2004,11:1179～1180.
22. Shelly WB, Hurley HJ. Studies on topical antiperspirant control of axillary hyperhidrosis . Acta Derou Venereol. (stockh),1975,55:241-60.
23. O JIM BA TA, CAMERONAE. Drawbacks of endoscopic thoracic sympathectomy [J]. Br J Surg, 2004, 91(8): 1072-1073.
24. Skelley W B,Floreflce R.Compensatory hyperhidrosis after sympathectomy.N Engl J Med,1960,263:1056-1058.
25. Sato K, Kang WH, Saga K, Sato KT. Biology of sweat glands and their disorders II. Disorders of sweat gland function. J Am Acad Dermatol, 1989;20(5Pt 1):713-26.
26. Wenzel FG, Horn TD. Nonneoplastic disorders of the eccrine glands.J Am AcadDermatol 1998;38:1-17.
27. Estelle B. Gauda, Reed Cooper, et al. Autonomic microganglion cells: a source of acetylcholine in the rat carotid body. J Appl Physiol 96: 384–391, 2004.
28. Bakhit C, Armanini M, Wong WLE, et al. Increase in nerve growth factor-like immunoreactivity and decrease in choline acetyltranferase following contusive spinal cord injury. Brain Res, 1991;554:264-271.
29. Weihe E, Schafer MK, Schutz B, Anlauf M, Depboylu C, Brett C, Chen L, and Eiden LE. From the cholinergic gene locus to the cholinergic neuron. J Physiol 92: 385–388, 1998.
30. 万选才, 杨天祝, 徐承焘, 主编. 现代神经生物学. 北京医科大学、中国协和医科大学联合出版社. 1999,1:123.
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