| Objective To study the relations intestinal mucosa leptin and leptin receptor and intestinal mucosa barrier damage on patients with obstructive jaundice, and to analyze its relationship with the damage of gut barrier.Methods 30 patients were choosed with obstructive jaundice treating pancreaticoduodenal resection or intestinal anastomosis in March 2012 to July 2013 in department of Hepatobiliary Surgery, Affiliated Hospital of Binzhou Medical College; Control group has 21 cases without jaundice. The experimental group were divided into mild jaundice group (≤171μmol/L, OJ1 group), moderately severe jaundice group (>171μmol/L, OJ2 group). To take part of jejunum mucosal in the specimen side quickly fixed in 10% formaldehyde solution to make paraffin section when cut off the jejunum.Firstly, to observe the change of small intestinal mucosa Lp and OB-R of patients with obstructive jaundice by immunohistochemical method, explore the relationship between intestinal mucosal leptin, its receptor and serum total bilirubin level.Secondly, to detect the expression of cell proliferation Ki-67 by immunohistochemical method, detect intestinal epithelial cell apoptosis by TUNEL, measure the intestinal villus height and crypt depth by HE dyeing; Observed the change of small intestinal villus height, crypt depth, ntestinal mucosa cell proliferation and apoptosis of patients with obstructive jaundice.Explore the relationship between testinal mucosal leptin, its receptor with intestinal mucosal damage of patients with obstructive jaundice.Finally, to detect the change of CD4+, CD8+T cell count by immunohistochemical method in small intestinal mucosa.analysis the relationship between the number of CD4+, CD8+ T cells and the serum total bilirubin concentration, and the relationship between leptin, its receptor and the number of CD4+, CD8+T cells.Results Firstly, the expression of intestinal mucosa leptin and its receptor of OJ group lower than the control group(LP:1.63±1.25,2.48±1.25, P<0.05; Ob-R: 2.63±1.27,3.90±1.00, P<0.05), the expression of leptin of OJ1 above OJ2 group, the difference is statistically significant (LP:2.12±1.11,1.00±1.15, P<0.05; Ob-R:3.29±0.77,1.77±1.30, P<0.05). The expression of leptin and OB-R were declined in intestinal mucosa along with the increase of bilirubin.Secondly, the small intestinal mucosa thickness of OJ group is decreases, the number of villi and density decreased, shorter length, mucosal villi interstitial is dropsical, crypt depth becomes shallow. The control group small intestinal mucosa is normal, the difference is statistically significant (P<0.05). OJ group proliferation index (8.43±1.43)%, the control group (13.61±2.41)%, OJ1 group (9.19±1.26) %, OJ2 group (7.44±0.97)%, compare the difference was statistically significant (P <0.05). OJ group cell apoptosis index was significantly higher than control group (21.72±5.07,13.57±3.59)%, OJ1 below OJ2 group (19.31±4.38,24.86±4.21)%, the difference was statistically significant (P<0.05). There was significant correlation between the expression of intestinal mucosa leptin, OB-R and intestinal mucosal cell proliferation, apoptosis and villus height, crypt depth of OJ group (P<0.01)Finally, CD4+, CD8+T cells in intestinal mucosa of OJ group were decreased obviously (OJ group 17.74±4.33,11.61±3.36; 28.33±4.53,15.95±3.69 in the control group), the difference was statistically significant (P<0.05). With the increase of blood bilirubin level, CD4+, CD8+ T cells in the intestinal mucosa number is on the decline. There was positive correlation between leptin, OB-R and CD4+ and CD8+ lymphocytes of OJ group.Conclusion This study results show that obstructive jaundice can influence the expression of bowel mucosa leptin and its receptor, intestinal mucosa cell proliferation and apoptosis, and the number of CD4+, CD8+ T cells in intestinal mucosa. Leptin and its receptor were linked to intestinal mucosal proliferation, apoptosis, and intestinal mucosal CD4+, CD8+ T cells. Speculated that leptin may have relationship with intestinal mucosal barrier, for obstructive jaundice caused by intestinal mucosal damage protection. Protect the intestinal mucosa with obstructive jaundice. |
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