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Abstract：
Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal (ICCs), as well as P2X3 receptors in ureteropelvic junction (UPJ) and the pain response in pediatric patients with hydronephrosis. Methods: 50 patients with congenital hydronephrosis underwent open or laparoscopic pyeloplasty at one of two departments of pediatric surgery and urology in Poland. Patients were divided into two groups according to the pain symptoms before surgery. A total of 50 samples of UPJ were obtained intraoperatively and underwent histopathological and immunohistochemical (IHC) analysis. Quantitative assessment of ICCs was based on the number of CD117(+) cells of adequate morphology in the subepithelial layer and the muscularis propria. Expression of P2X3 receptors was evaluated as the intensity of IHC staining. Results: Patients with hydronephrosis and accompanying pain were on average 60 months older (77 vs. 17 months) than children with asymptomatic hydronephrosis (p = 0.017). Symptomatic children revealed higher numbers of ICCs in both the subepithelial layer and in the lamina muscularis propria. In particular, symptomatic patients aged 2 years or more exhibited significantly higher numbers of ICCs in the subepithelial layer. Significant differences in the distribution of ICCs between the subepithelial layer and the lamina muscularis propria were observed in both groups. Expression of P2X3 receptors was limited to the urothelium and the muscle layer and correlated between these structures. There was no relationship between pain response and the expression of P2X3 receptors. Conclusions: ICCs and P2X3 receptors may participate in the pathogenesis of UPJO and in the modulation of pain response to a dilatation of the pyelocaliceal system. Explanation of the role of ICCs and P2X3 receptors in propagation of ureteral peristaltic wave and the modulation of pain stimuli requires further studies.
摘要：
简介：儿童人群中肾盂输尿管连接部梗阻（UPJO）的病因和症状学尚未明确阐明，表明该条件具有多因素性质。目的是分析Cajal间质细胞(ICC)数量之间的关联，以及肾盂输尿管连接（UPJ）中的P2X3受体和小儿肾积水患者的疼痛反应。方法：50例先天性肾积水患者在波兰小儿外科和泌尿外科两个科室之一接受了开放或腹腔镜肾盂成形术。根据患者术前疼痛症状分为两组。术中总共获得了50个UPJ样品，并进行了组织病理学和免疫组织化学（IHC）分析。ICC的定量评估是基于上皮下层和固有肌层中具有适当形态的CD117（）细胞的数量。将P2X3受体的表达评估为IHC染色的强度。结果：肾积水和伴随疼痛的患者平均年龄为60个月（77vs.17个月）比无症状肾积水的儿童（p=0.017）。有症状的儿童在上皮下层和固有肌层中均显示出较高的ICC数量。特别是,2岁或以上有症状的患者在上皮下表现出更高的ICC数量.在两组中，上皮下层和固有肌层之间的ICC分布存在显着差异。P2X3受体的表达仅限于尿路上皮和肌肉层，并且在这些结构之间具有相关性。疼痛反应与P2X3受体的表达之间没有关系。结论：ICC和P2X3受体可能参与了UPJO的发病机理，并参与了对肾盂动脉系统扩张的疼痛反应的调节。解释ICC和P2X3受体在输尿管蠕动波传播和疼痛刺激调节中的作用需要进一步研究。
