| Objective: 1.The aim of the study was to analyse and speculate the IL-4 and IL-13 in the serum and LES of the AC patients,and discuss the significance of IL-4,IL-13 in pathogeny of the AC,in order to supplement the evidence study on etiology of AC and provide a new guidance for clinical treatment of AC.2.Another purpose of this study was to assess the effect of poetry in the treatment of achalasia,which were followed up more than 3 years,with particular emphasis on POEM failures and associated risk factors.Methods: We collected the information of 54 cases with AC as the experience group,who were diagnosed in General Hospital of Chengdu Military Region,and received POEM from February 2014 to February 2015.We preserved their fasting peripheral blood and LES tissue samples during the POEM procedure,in addition,we collected the information of 53 cases as the healthy control group,who are diagnosed as cardiac tumors originating from the muscularis propria and they received the treatment of STER from February2014 to February 2015 in our hospital.We preserved their fasting peripheral blood and LES tissue samples during the STER procedure.Moreover,we collected 40 cases who were healthy,and preservded their fasting peripheral blood serum as the healthy control group.We used ELISA to measure the levels of IL-4 and IL-13 in the serum,and we used nohistochemical method to measure the levels of IL-4 and IL-13 in the LES.The factors of the level of serum IL-4 and IL-13 in AC patients were also discussed.Moreover,weevaluated the efficacy of POEM,and layed stress on POEM failures and associated risk factors.The data were statistically analyzed by Graph Pad Prism7.0 and SPSS17.0 statistical software.Results: 1.The AC experimental group included 54 patients,among them,29 were male,25 were female,age(43.32±12.71)years;40 patients were fited into the healthy control group,among them,19 cases were male,21 cases were female,age(43 ±5.30)years;MPTs control group included 53 patients,among them,29 cases were male,25 cases were female,age(45.38±8.15)years.There was no statistical difference in epidemiological data between groups(sex and age)(P > 0.05).2.The concentration of the serum IL-4 and IL-13 in each group:(1)IL-4 in AC experimental group(53.02±7.41 pg/ml)were higher than that in the health control group(45.63 ± 4.36 pg/ml),the difference was considered statistically significant(t=5.831,P < 0.0001);IL-13 in AC group(34.43±3.44 pg/ml)were higher than that in the health control group(22.33 ±2.50 pg/ml),the difference was considered statistically significant(t = 4.032,P < 0.0001);(2)IL-4 in AC experimental group(53.02±7.41 pg/ml)were higher than that in the MPTs control group(43.17±3.32 pg/ml),the difference was considered statistically significant(t = 5.961,P < 0.0001);IL-13 in AC group(34.43 ±3.44pg/ml)were higher than that in the health control group(22.03±1.94 pg/ml),the difference was considered statistically significant(t = 4.027,P < 0.0001);(3)The serum IL-4 and IL-13 levels in the healthy control group and MPTs control group both had no significant difference(P > 0.05).(4)There was a significant positive correlation between the expression of IL-4 and IL-13 in the serum of the patients in the AC experimental group(r = 0.867,P < 0.0001).3.The analysisof IL-4 and IL-13 in LES between the experimental group and control group MPTs:(1)In the cytoplasm and nucleus,the accumulated optical density of IL-4 in AC patients' s LES(15786.18 ± 1366.89)were higher than that in MPTs control group(5681.56 ± 834.52),the difference was considered statistically significant(t=2.674,P<0.0001);(2).In the cytoplasm and nucleus,the accumulated optical density of IL-13 in AC patients' s LES(10416.24 ± 545.71)were higher than that in MPTs control group(5023.64 ± 597.62),the difference was considered statistically significant(t=3.318,P = 0.035);(3).IL-4 and IL-13 expression in LES tissues of AC patients in the experiment was positively correlated(r=0.613,P<0.0001).5.The correlation analysis between IL-4,IL-13 and the disease duration,the history of interventional procedures before POEM:(1).There is no correlation between the disease duration and the serum levels of IL-4 and IL-13 in AC patients(P > 0.05);(2)IL-4 in AC experimental group(59.92 ± 9.28pg/ml)were higher than that in MPTs and control group(51.54 + 8.38 pg/ml),and IL-13 in AC experimental group(37.23 + 6.10 pg/ml)were higher than that in MPTs and control group(34.45 ± 2.75 pg/ml),the difference between the two groups was statistically significant(P < 0.05).5.Outcomes of POEM for treatment of esophageal achalasia:(1)The barium meal examination showed that the residual barium 1min and 5min were lower than the preoperative,and the esophageal emptying rate were higher than before,the difference between the two groups was statistically significant(P < 0.05);(2)The postoperative mean resting pressure was lower than that before operation,and the difference was statistically significant(P < 0.05),but there was no significant difference in postoperative LES length and LES relaxationrate between preoperative and postoperative(P > 0.05);(3)All subjective indicators were better than before(P < 0.05),in which each symptom scores in Eckardt were alleviated,no weight loss in all patients after surgery.(4)The statistical analysis found that the estimated clinical success rates at 6 months,1year,2 years,3 yeats,4 years were 98.15%,94.44%,88.89%,77.78%,and the estimated clinical success rates at 6 months(P = 0.002)was higer than 3 years,and the estimated clinical success rates at 1 months(P = 0.023)was higer than 3 years,difference was condidered statistically significant;(5)the Logistic regression analysis found that high levels of serum IL-4,IL-13 and the history of preoperative interventional therapy were the risk factors of recurrence afte r POEM.Con cl usi on: 1.IL-4 an d IL-13 ma y be the pathogenesis of achalasia,and may have synergy in the process of disease participate.2.The levels of serum IL-4 and IL-13 in patients with achalasia are positively related to the history of preoperative intervention in patients with achalasia.3.The pathogenesis of AC is closely related to the autoimmune reaction,and our study proved that the inflammatory reaction caused by the damage of the autoimmune system is an important cause and mechanism of AC.4.The treatment of POEM was safe and effective,and can significantly reduce the clinical symptoms of patients.5.The symptoms of the patients who received POEM have a trend of aggravation after 2-3 years,and need to s t r e n g t h e n t h e fo l l o w-u p mo n i t o r in g.6.t h e h i s t o r y o f p r e o p e r a t i v e interventional therapy and the leves of serum IL-4 and IL-13 were the risk factors for the recurrence of AC patients who received the treatment of POEM. |
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