Clinical Significance Of The Expression Of Adenosine A2B Receptor In Children With Intestinal Necrosis Of Acute Intestinal Obstruction

Objective:To observed and investigated the expression change of A2 B adenosine recptor(A2BAR) in intestinal epithelial cells of intestinal necrosis in children with acute intestinal obstruction and its possible mechanism and clinical significance.Methods:Collected 42 cases of emergency admission from September 2014 to October 2015 as the first symptom of acute intestinal obstruction in children, and then perform emergency surgical exploration after admission. Intraoperative findings induced the color of association becoming black and loss of peristalsis, considering intestines necrosis,undergoing intestinal resection and anastomosis, postoperative pathology confirmed intestinal necrosis, as the lesions; Selected 20 patients with digestive tract malformation in children as the control group(such as Meckel’s diverticulum, intestinal duplication, ect), no fever, infection and upper respiratory tract infections and other primary diseases and complications, undergoing intestinal resection and anastomosis. We used Immunohistochemistry(IHC) techniques to detect and observe the expression of A2 BAR and tight junctions Occludin in intestinal mucosa epithelial cells, through the Scanscope digital pathology scanning system of American Aperio company for semi-quantitative analysis, detected the average gray value of positive reaction products of both.Enzyme-linked immunosorbent assay(ELISA) were used to detect the concentration levels of serum tumor necrosis factor-α(TNF-α) in pre and postoperative 7 days of both. The expression of p38 Mitogen Activated Protein Kinase(p38MAPK) and phosphorylation of p38 Mitogen Activated Protein Kinase(p-p38MAPK) in intestinal epithelial cells were determined by Western Blot(WB).Result:1. The staining intensity of lesion group A2 BAR was stronger than that of the control group, more positive reaction products expressed widely in the apical membrane and basement membrane of intestinal mucosal epithelial cells, while the control group A2 BAR expressed less, lighter staining, the average gray value of lesion group significantly was lower than that of control group(P<0.001);2.The tight junctions Occludin of lesion group had less positive reaction product,showed lighter staining, decreased expression level, uneven distribution, discontinuous change. In control group, the expression of tight junctions Occludin was more than that of lesion group, the staining was deeper and the continuity was complete, the average gray value of lesion group was significantly higher than that of control group(P<0.001);3.Preoperatively concentration of TNF-α in serum of lesion group was significantly higher than that of control group(P<0.001); After surgical treatment of primary disease,postoperative positive anti-infection rehydration symptomatic and supportive treatment of lesion group, the level of serum TNF-α concentration in postoperative 7 days was significantly lower than pre(P<0.001); Compared the control group with the lesion group,there was no significant difference of serum TNF-α concentration in postoperative 7 days(P>0.05).4.Compared with the control group, the lesion group had no significant difference of the expression of p38 MAPK in intestinal mucosa epithelial cells, but the expression of p-p38 MAPK significantly increased.5.Correlation Analysis: The preoperative concentration of serum TNF-α and the average gray value of A2 BAR were negatively correlated in lesion group(r=-0.694,P<0.01), the average gray value of A2 BAR was negatively correlated with tight junctions Occludin.(r=-0.581, P<0.01).Conclusion:1.When children got acute intestinal obstruction, early intestinal ischemia and TNF-αrelease induced by hypoxia, sustained hypoxia and high concentration of TNF-α can induce the expression of A2 BAR on the surface of intestinal epithelial cells.2.Persistent intestinal ischemia, A2 BAR was activated, then started and activated intracelluar p38 MAPK signal transduction pathway, could be one of the the mechanisms of caused by the decreased expression of tight junctions Occludin, the translocated of bacterial and endotoxin translocation.3.The increase of A2 BAR expression may be involved in the pathogenesis of intestinal mucosal barrier injury and destruction, and it will be expected to become a potential therapeutic target for the treatment of acute intestinal obstruction in children.