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氧化应激在小儿反流性食管炎黏膜损伤中的作用
Role of oxidative stress in the pathogenesis of esophageal mucosal injury in children with reflux esophagitis
目的：胃食管反流引起食管黏膜损伤的机制尚不清楚，该研究主要探讨氧化应激在小儿反流性食管炎（RE）黏膜损伤中的作用。方法：对36例（年龄7个月至16岁）经胃镜检查诊断为RE的患儿，测定其食管黏膜氧化应激指标如丙二醛（MDA）、谷胱甘肽（GSH）和一氧化氮（NO）的含量和总超氧化物歧化酶（T-SOD）活力及蛋白质含量。另20例（年龄3～16岁）胃镜检查时未发现食管黏膜损伤者作为对照组。结果：食管黏膜蛋白质含量在两组间差异无显著性意义（P>0.05）；RE组MDA值为每毫克蛋白15.36±16.67 nmol，高于对照组的7.51±6.17 nmol，差异有显著性意义（P<0.01）；RE组T-SOD活力每毫克蛋白为30.43±35.09 U低于对照组的56.34±51.73 U，差异有显著性意义（P<0.05）；而GSH和NO的含量在两组间差异无显著性意义（P>0.05）。结论：RE时食管黏膜MDA含量升高，SOD活力水平降低，表明氧化应激损伤在小儿食管黏膜损伤中起重要作用。［中国当代儿科杂志，2009，11（6）：425-428］
OBJECTIVE: To investigate the role of oxidative stress in the pathogenesis of esophageal mucosa injury in children with reflux esophagitis (RE). METHODS: Esophageal mucosal samples from 36 children with RE (7 months to 16 years of age) were obtained by gastroscopy. The parameters of oxidative stress, including the contents of malondialdehyde (MDA), glutathione (GSH) and nitric oxide (NO) and total superoxide dismutase (T-SOD) activity in the esophageal mucosa as well as the protein content of the esophageal mucosa, were measured. Twenty children (3 to 16 years of age) without esophageal mucosal injury by gastroscopy served as controls. RESULTS: There was no significant difference in the protein content of the esophageal mucosa between the RE and the control groups. The content of MDA in the RE group (15.36±16.67 nmol/mg) was significantly higher than that in the control group (7.51±6.17 nmol/mg) (P<0.01). The activity of T-SOD in the RE group (30.43±35.09 U/mg) was statistically lower than that in the control group (56.34±51.73 U/mg) (P<0.05). No significant differences were observed in GSH and NO contents between the two groups. CONCLUSIONS: The MDA content increases and the SOD content decreases in the esophageal mucosa in children with RE. This suggests that oxidative stress seems to be an important mediator in generation of esophageal mucosal injury.［Chin J Contemp Pediatr, 2009, 11 (6):425-428］
Gastroesophageal reflux disease / Reflux esophagitis / Oxidative stress / Child
［1］Farhadi A, Fields J, Banan A, Keshavarzian A. Reactive oxygen species: are they involved in the pathogenesis of GERD, Barrett′s esophagus, and the latter′s progression toward esophageal cancer?［J］. Am J Gastroenterol, 2002, 97(1):22-26.
［2］Erbil Y, Turkoglu U, Barbaros U, Balik E, Olgac V, Kaya H, et al. Oxidative damage in an experimentally induced gastric and gastroduodenal reflux model［J］. Surg Innov, 2005, 12(3):219-225.
［3］Rantanen TK, Rasanen J, Sihvo EI, Ahotupa MO, Farkkila MA, Salo JA.The impact of antireflux surgery on oxidative stress of esophageal mucosa caused by gastroesophageal reflux disease: 4-yr follow-up study［J］.Am J Gastroenterol, 2006, 101(2):222-228.
［4］《中华儿科杂志》编辑委员会, 中华医学会儿科学分会消化学组. 小儿胃食管反流病诊断治疗方案(试行) ［J］. 中华儿科杂志, 2006, 44(2):97.
［5］Madamanchi NR, Vendrov A, Runge MS. Oxidative stress and vascular disease［J］. Arterioscler Thromb Vasc Biol, 2005, 25(1):29-38.
［6］高艳青，刘晓霓，宋小莉，司银楚，牛欣. 氧化应激在反流物所致食管黏膜损伤中的作用［J］. 中国病理生理杂志, 2004, 20(2):149-153.
［7］Oh TY, Lee JS, Ahn BO, Cho H, Kim WB, Kim YB, et al. Oxidative stress is more important than acid in the pathogenesis of reflux oesophagitis in rats［J］.Gut, 2001, 49(3):364-371.
［8］Oh TY, Lee JS, Ahn BO, Cho H, Kim WB, Kim YB, et al. Oxidative damages are critical in pathogenesis of reflux esophagitis: implication of antioxidants in its treatment［J］. Free Radic Biol Med, 2001, 30(8):905-915.
［9］Wetscher GJ, Hinder RA, Klingler P, Gadenstatter M, Perdikis G, Hinder PR. Reflux esophagitis in human is a free radical event［J］. Dis Esophagus, 1997, 10(1):29-32.
［10］Li Y, Wo JM, Su RR, Ray MB, Martin RC. Loss of manganese superoxide dismutase expression and activity in rat esophagus with external esophageal perfusion［J］. Surgery, 2007,141(3):359-367.
［11］Lanas A, Soteras F, Jimenez P, Fiteni I, Piazuelo E, Royo Y, et al. Superoxide anion and nitric oxide in high-grade esophagitis induced by acid and pepsin in rabbits［J］. Dig Dis Sci, 2001, 46(12):2733-43.
［12］Jimenez P, Piazuelo E, Sanchez MT, Ortego J, Soteras F, Lanas A. Free radicals and antioxidant systems in reflux esophagitis and Barrett′s esophagus［J］. World J Gastroenterol, 2005, 11(18):2697-2703.
［13］Ozel Sk, Dagli TE, Yuksel M, Kiyan G, Kotiloglu E. The roles of free oxygen radicals, nitric oxide, and endothelin in caustic injury of rat esophagus［J］. J Pediatr Surg, 2004, 39(9):1381-1385.
［14］Inamori M, Shimamura T, Nagase H, Abe Y, Umezawa T, Nakajima A, et al. mRNA expression of inducible nitric oxide synthase, endothelial nitric oxide synthase and vascular endothelial growth factor in esophageal mucosa biopsy specimens from patients with reflux esophagitis［J］. Hepatogastroenterology, 2006, 53(69):361-365.
［15］Tomita R, Tanjoh K, Fujisaki S, Fukuzawa M. Physiological studies on nitric oxide in the lower esophageal sphincter of patients with reflux esophagitis［J］. Hepatogastroenterology, 2003, 50(49):110-114.
