细胞因子在感染后肠易激综合征及溃疡性结肠炎缓解期肠黏膜中的表达

临床发现约1/3肠易激综合征(irritable bowel syndrome,IBS)患者患病前曾有急性胃肠道感染史,称之为感染后肠易激综合征(post-infective irritable bowel syndrome,PI-IBS)[1].     

感染后肠易激综合征

越来越多的流行病学和临床资料表明早期胃肠道感染与肠易激综合征(irritable bowel syndrome,IBS)的关系密切。大部分胃肠道感染患者能够很快恢复并且无后遗症,但是仍有一部分患者会有持续性的症状,符合IBS的诊断标准,即为感染后肠易激综合征(post-infectious irritable bowel syndrome,PI-IBS)。本文综合国内外有关PI-IBS的研究进展,从PI-IBS的流行病学特征、相关危险因素、病理生理学改变以及临床特征等方面进行作一概述。     

基于肠道菌群代谢产物探索低FODMAPs饮食对腹泻型肠易激综合征的疗效及机制研究

背景肠易激综合征(irritable bowel syndrome, IBS)的发生与肠道菌群紊乱引起代谢产物异常改变相关.低可发酵的寡糖、双糖、单糖、多元醇(fermentable oligosaccharides,disaccharides,monosaccharides and polyols, FODMAPs)饮食在IBS治疗上是否通过影响肠道菌群代谢产物苯丙氨酸(phenylalanine, PHE)的产生进而起到治疗作用的研究具有重要意义.目的观察低FODMAPs饮食在腹泻型IBS(diarrhea-type irritable bowel syndrome,IBS-D)治疗上的疗效及其通过肠道菌群代谢产物PHE调控胰高血糖素样肽-1(glucagon-like peptide-1, GLP-1)的分子机制.方法选择30例符合罗马Ⅳ标准的IBS-D患者入组,予低FODMAPs饮食,疗程4周.征集30名健康志愿者作基线检测对照.观察健康志愿者及IBS组患者治疗前后的临床症状评分,检测血清PHE, GLP-1, TNF-α, IFN-γ.采用NCI-H716细胞,加入不同浓度PHE,观察PHE对GLP-1的影响.结果经低FODMAPs饮食干预后, IBS患者临床症状评分较治疗前明显降低(P0.0001P0.001); IBS组血清PHE和GLP-1浓度较前上升(P0.05), TNF-α和IFN-γ浓度较前下降(P0.0001P0.001).试验过程中无一例出现不良反应.体外实验发现, 1 mmol/L PHE可以显著促进GLP-1分泌.结论低FODMAPs饮食能改善IBS-D患者临床症状,其作用机制可能与饮食因素影响肠道菌群代谢产物PHE调控GLP-1,抑制促炎细胞因子分泌相关.     

谢晶日运用风药治疗腹泻型肠易激综合征经验

肠易激综合征(irritable bowel syndrome,IBS)是一种临床上常见的功能性肠病,以腹痛、排便习惯改变、大便性状异常为主要症状,而无胃肠道结构或者生化检查异常。[1]。根据其典型异常排便习惯中的粪便性状,IBS可以被分为4种亚型,即腹泻型、便秘型、混合型和不定型[2],其中以腹泻型肠易激综合征(diarrhoeal irritable bowel syndrome,IBS-D)最常见。西医尚缺乏某一完全有效的药物或疗法,主要是对症治疗。     

吸烟对早期糖尿病肾病静息能量消耗的影响

目的 观察吸烟对早期糖尿病肾病静息能量消耗(REE)的影响及与氧化应激和炎症反应之间的关系.方法 对31例吸烟和40例非吸烟的早期糖尿病肾病患者的一般情况、临床特征、REE、REE与去脂组织(FFM)的比值、氧化应激及炎症反应标志物进行比较分析.结果 吸烟组的REE/FFM比非吸烟组显著增高15.96%(P=0.001).相关分析提示,REE/FFM的增高与吸烟有关(t=0.395,P=0.001).氧化应激标志物丙二醛(MDA)、超氧化物歧化酶(SOD)和炎症反应标志物高敏C反应蛋白(hs-CRP)两组间差异有统计学意义(P＜0.05),脂联素、TNFα组间差异无统计学意义(P＞0.05),REE/FFM的增高与MDA、SOD、hs-CRP、脂联素、TNFα均不相关(P＞0.05).结论 吸烟可导致早期2型糖尿病肾病患者REE增加,引起氧化应激和炎症反应,但REE增高与氧化应激和炎症反应无关.     

胃肠道动力异常在肠易激综合征发病中的作用

肠易激综合征(irritable bowel syndrome,IBS)是一种常见的功能性肠病,其腹痛、腹部不适与排便相关,伴有排便习惯、粪便性状的改变[1],缺乏可解释这些症状的器质性疾病.IBS症状呈慢性、反复发作,严重影响患者生活质量.罗马Ⅲ标准将.IBS分为便秘型(IBS-c)、腹泻型(IBs-D)、混合型和不定型4种亚型,临床上以.IBS-D、IBS-c常见.IBS的发病可能与胃肠道动力异常、内脏高敏感、感染后炎症、脑.肠轴功能异常、遗传和环境因素以及精神心理障碍等有关,动力异常一直被认为是IBS病理生理机制的主要环节之一.     

固本涩肠方可抑制腹泻型肠易激综合征患者的炎症和氧化应激反应

目的 肠易激综合征(irritable bowel syndrome, IBS)是一种常见的慢性、复发性和功能性胃肠道疾病。根据粪便类型不同将IBS分为腹泻型(diarrhea-predominant, IBS-D)、便秘型(constipation-predominant, IBS-C)和交替型(alternating, IBS-A)。鉴于IBS亚型临床表现和病理生理机制的差异,不同IBS亚型对治疗的反应是不同的。本研究旨在评估固本涩肠方对IBS患者炎症细胞因子(IL-17、IL-10、TNF-α)和氧化应激生物标志物[丙二醛(malondialchehyche, MDA)和总抗氧化能力(total antioxidant capacity, TAOC)]的影响。方法 本研究为在我院进行的一项为期2个月的平行、双盲、随机、安慰剂对照试验。于2020年4月和2021年8月,招募了88例年龄在18至70岁之间的女性和男性IBS患者。IBS的诊断依据罗马III诊断标准。受试者按照1∶1被随机分为干预组(固本涩肠方)和安慰剂组。干预组和安慰剂组患者口服3袋/次/天固本涩肠方或匹配的安慰剂,持...     

肠易激综合征焦虑抑郁治疗的研究进展

<正>肠易激综合征(irritable bowel syndrome,IBS)是临床上最常见的一种胃肠道功能紊乱性疾患,是一组包括腹痛、腹胀、腹部不适、以大便习惯改变为主要特征,并伴大便性状异常,持续存在或间歇发作,而又缺乏形态学和生物化学异常改变等可用器质性疾病解释的临床症状。罗马Ⅲ诊断标准根据大便的性状将IBS细分为4个主要临床亚型,即IBS腹泻型(IBS-D),IBS便秘型(IBS-C),IBS混合型     

基于低FODMAP饮食联合灸法的整体护理模式在肠易激综合征患者护理中的应用研究

背景由于肠易激综合征腹泻型(irritable bowel syndrome diarrheatype,IBS-D)严重影响患者生活质量,常规饮食指导及常规护理效果不佳,因此寻找一种安全有效的护理模式对于缓解病情,提升患者生活质量具有重要意义.目的分析基于低可发酵低聚糖,二糖,单糖,多元醇(fermentable oligosaccharides, disaccharides,monosaccharides,polyols,FODMAP)饮食联合灸法的整体护理模式在IBS-D患者护理中的应用效果.方法选择2018-09/2020-06我院住院部收治的100例IBS-D患者,按随机数表法分组,对照组(50例)接受经典肠易激综合征(irritable bowel syndrome, IBS)饮食指导与常规护理,研究组实施基于低FODMAP饮食联合灸法的整体护理模式.观察两组干预前后主要症状评分、IBS病情严重程度量表(IBS-SSS)评分、IBS相关生活质量量表(IBS-QOL)评分、Bristol粪便性状量表评分、血清脑肠肽水平[血管活性肠肽(vasoactive intestinal peptide, VIP)、5-羟色胺(5-hydroxytryptamine,5-HT)、P物质(substance P, SP)]、肠道主要菌群变化.结果研究组干预后主要症状评分、IBS-SSS评分、Bristol粪便性状量表评分比对照组低, BS-QOL评分比对照组高(P0.05);研究组干预后血清VIP、5-HT、SP水平比对照组低(P0.05);研究组干预后双歧杆菌、乳酸杆菌、大肠杆菌数量相比对照组,差异无统计学意义.研究组饮食总依从率(96.00%)比对照组(82.00%)高(P0.05).结论基于低FODMAP饮食联合灸法的整体护理模式在IBS-D患者护理中具有一定可行性,可减轻临床症状,提升饮食依从性,改善生活质量,调节血清脑肠肽水平,且对肠道主要菌群无明显影响.     

直肠黏膜酪酪肽(PYY)表达在肠易激综合征诊断中的价值

目的观察直肠黏膜酪酪肽(peptide tyrosine tyrosine,PYY)表达能否作为临床诊断肠易激综合征(irritable bowel syndrome,IBS)有效的生物标志物。方法对照组21名,IBS组80例(IBS-C组41例,IBS-D组39例)进行电子结肠镜检查,均在距肛直肠15 cm直肠黏膜取活检做PYY免疫组化检查,并统计阳性PYY细胞数。结果 IBS总体直肠黏膜PYY阳性细胞数量计分1.51±0.67,对照组直肠黏膜PYY阳性细胞数量计分2.38±0.92,两组差异有统计学意义(P0.05)。结论直肠黏膜PYY表达可作为临床诊断IBS有效的生物标志物。     

感染后肠易激综合征患者肠黏膜细胞因子表达的相关性研究

临床发现,约1/3的肠易激综合征(irritable bowel syndrome,IBS) 患者在其患病前曾有急性胃肠道感染史;部分被肠道病毒、细菌或寄生虫感染的患者,在病原体已清除及黏膜炎症消退后,可发生IBS样的症状,称之为感染后肠易激综合征(postinfectious irritable bowel syndrome, Pl-IBS)~([1]).     

感染对IBS患者肠黏膜细胞因子表达的影响

目的:探讨感染对肠易激综合征(irritable bowel syndrome,IBS)患者神经-免疫-内分泌网络的影响.方法:感染后肠易激综合征(postinfectious irritable bowel syndrome,PI-IBS)患者45例,non-PI-IBS患者60例及30例对照者,结肠镜下活检回盲部黏膜标本,采用免疫组织化学法检测其肠黏膜SP、IL-2、IFN-γ、SPR与5-HT的表达,肥大细胞(mast cells,MC)采用甲苯胺蓝染色.结果:PI-IBS患者的SP表达分别高于non-PI-IBS与对照组(t=2.5,2.8,P<0.01);PI-IBS患者的MC表达分别高于non-PI-IBS与对照组(t=11.5,12.1,P<0.01).PI-IBS患者的5-HT表达分别高于non-PI-IBS与对照组(t=13.6,14.1,P<0.01);PI-IBS患者的SPR表达分别高于non-PI-IBS与对照组(t=3.8,6.1,P<0.05);PI-IBS患者的IFN-γ表达分别高于non-PI-IBS与对照组(t=13.8,15.2,P<0.05);PI-IBS患者的IL-2表达分别高于non-PI-IBS与对照组(t=12.6,14.7,P<0.05).PI-IBS患者回盲部黏膜MC和SP的表达呈高度正相关(r=0.71,P<0.01).PI-IBS患者回盲部黏膜5-HT和SPR的表达呈密切相关(r=0.18,P<0.05).IFN-γIL-2阳性表达的PI-IBS患者,SP表达高于非PI-IBS组(r=2.2,2.3,P<0.05)和对照组(t=2.3,2.4,P<0.05).结论:肠道感染后,神经纤维在IBS的免疫-神经-内分泌发生机制中的作用至关重要.     

炎症免疫与肠易激综合征关系的研究进展

肠易激综合征(irritable bowel syndrome,IBS)是一组以腹痛、腹胀以及排便习惯改变为主要症状的慢性功能性肠道疾病.近些年大量研究表明肠黏膜炎症免疫在IBS的发病机制中起了重要的作用,本文综述了肠黏膜炎症免疫与IBS关系的研究进展.     

肥大细胞与肠易激综合征关系的研究进展

肠易激综合征(irritable bowel syndrome,IBS)的发病机制复杂,目前普遍认为IBS与感染和炎症、内脏高敏、肠道局部神经-内分泌-免疫系统紊乱、心理压力及肠道食物过敏等多因素有关.近年来IBS的低度炎症更是关注的热点,尤其是肥大细胞与IBS的关系探讨.多项研究结果表明IBS肠道肥大细胞的数量及表达...     

脐针治疗腹泻型肠易激综合征疗效及对脑肠肽的影响

背景肠易激综合征(irritable bowel syndrome, IBS)的发生与脑-肠轴失调相关.脐针具有缓解痉挛,治疗腹泻的作用.我们假设:腹泻型肠易激综合征(diarrhea-type irritable bowel syndrome, IBS-D)存在脑肠肽分泌紊乱,脐针通过调控脑肠肽分泌改善IBS患者症状.目的探讨脐针治疗IBS-D患者的临床疗效及其对血清脑肠肽的影响.方法 60例患者符合罗马Ⅳ制定的IBS-D的诊断标准,单盲随机分为2组:脐针组30例,予脐针;益生菌组30例,予地衣芽孢杆菌胶囊治疗,疗程均4周.同时征集30名健康志愿者作基线检测对照.观察2组患者治疗前后的临床症状评分, SF-36量表评分,汉密尔顿抑郁量表(hamilton depression scale, HAMD)及汉密尔顿焦虑量表(hamilton anxiety scale, HAMA)评分,血清5-羟色胺(5-hydroxytryptamine, 5-HT),降钙素基因相关肽(calcitonin gene-related peptide, CGRP), P物质(substance P, SP),一氧化氮(nitricoxide, NO),血管活性肠肽(vasoactive intestinal peptide, VIP)含量的变化.试验过程中无一例出现不良反应.结果治疗后脐针组及益生菌组的临床症状评分明显低于治疗前(P=0.000);治疗后脐针组及益生菌组SF-36量表评分明显高于治疗前(P=0.000),HAMD及HAMA评分明显低于治疗前(P=0.000);治疗后脐针组及益生菌组患者血清5-HT, CGRP, SP, NO, VIP含量显著下降(P0.0001).结论脐针能有效改善IBS-D患者的临床症状及心理精神状态,提高生活质量,其作用机制可能通过降低5-HT,CGRP,SP,NO, VIP水平,调节脑肠肽分泌相关.其治疗效果与益生菌制剂相当.     

结肠黏膜褪黑素受体表达与肠易激综合征症状相关性研究

目的研究结肠黏膜褪黑素受体(melatonin receptor,MR)与肠易激综合征(irritable bowel syndrome,IBS)症状的相关性。方法 IBS入选标准参照罗马Ⅲ标准,IBS患者90例(IBS-D 46例,IBS-C 44例),正常对照者19名,进行电子肠镜检查,均在直乙状结肠交界处取活检做MR免疫组化检查,并记录IBS症状积分。结果 IBS-C患者结肠黏膜MR表达(2.48±0.63)高于正常对照组(2.05±0.78)、IBS-D组(1.41±0.50),组间比较,差异有统计学意义(P0.05)。IBS患者MR表达与IBS症状相关(P=0.024,r=0.238)。结论 IBS患者结肠黏膜MR表达异常,与IBS症状相关,提示可能与IBS动力异常、内脏高敏感有关。     

Post-infectious irritable bowel syndrome

Post-infectious irritable bowel syndrome （PI-IBS） is a common disorder wherein symptoms of IBS begin after an episode of acute gastroenteritis. Published studies have reported incidence of PI-IBS to range between 5% and 32%. The mechanisms underlying the development of PI-IBS are not fully understood, but are believed to include persistent sub-clinical inflammation, changes in intestinal permeability and alteration of gut flora. Individual studies have suggested that risk factors for PI-IBS include patients＇ demographics, psychological disorders and the severity of enteric illness. However, PI-IBS remains a diagnosis of exclusion with no specific disease markers and, to date, no definitive therapy exists. The prognosis of PI- IBS appears favorable with spontaneous and gradual resolution of symptoms in most patients.     

肠易激综合征细胞因子失衡与肠黏膜屏障损伤的相关性

肠易激综合征(irritable bowel syndrome,IBS)作为临床常见病与多发病,目前已受到越来越多的关注.近些年来,随着细胞生物学和分子生物学的研究不断开展及PI-IBS概念的提出,对于IBS相关病理机制的探讨已逐渐由功能性向器质性过渡.为了将更加实用的药物应用于IBS的临床治疗,研究者逐渐着眼于IBS与炎性因子失衡、肠黏膜屏障损伤的相关性研究.探讨IBS细胞因子失衡与肠黏膜损伤的相关性,是为了在探寻IBS有效治疗药物的征途中开发和评估新的治疗措施,为更好的治疗本病提供新的思路.     

Irritable bowel syndrome consulters in Zhejiang province： The symptoms pattern, predominant bowel habit subgroups and quality of life

AIM: To investigate the pattern of symptoms, predominant bowel habits and quality of life (QOL) by the Chinese version of the SF-36 in irritable bowel syndrome (IBS) consulters in Zhejiang province. METHODS: From January 2001 to January 2002, 662 Roma Ⅱ criteria-positive IBS patients were enrolled by gastroenterologists in 10 hospitals from Digestive Disease Center of Zhejiang (DDCZ). Patients were classified into constipation predominant IBS (IBS-C), diarrhea predominant IBS (IBS-D) and alternating constipation and diarrhea IBS (IBS-A) according to the predominant bowel habits. All patients were evaluated for the demographic checklists, IBS bowel symptoms, extra-colonic symptoms, and QOL by Chinese version of the SF-36 questionnaire. RESULTS: (1) Besides abdominal pain, the predominant colonic symptoms were in order of altered stool form, abnormalities of stool passage, abdominal distension and passage of mucus in IBS patients. Also, IBS subjects reported generalized body discomfort and psychosocial problems including dyspeptic symptoms, poor appetite, heartburn, headache, back pain, difficulty with urination, fatigue, anxiety and depression. (2) IBS-C and IBS-A are more common among female patients, whereas male patients experienced more cases of IBS-D. In regards to the IBS symptoms, there were significant differences among IBS subgroups. Abdominal pain (frequency ≥2 days per week and duration ≥1 hour per day) was frequent in IBS-A patients (P=0.010 and 0.027, respectively), IBS-D patients more frequently experienced the passage of mucus, dyspeptic symptoms and anxiety (P=0.000, 0.014 and 0.015, respectively). (3) IBS patients experienced significant impairment in QOL, decrements in QOL were most pronounced in vitality, general health, mental health, and bodily pain. Compared with the general population (adjusted for gender and age), IBS patients scored significantly lower on all SF-scales (P&lt;0.001), except for physical function scale (P=0.149). (4) QOL was impaired in all subgroups, particularly in scales of vitality, general health and mental health. Compared with IBS-D, QOL in IBS-C scored significantly lower on physical function, role physical, general health, role emotional, and mental health scales (P=-0.037, 0.040, 0.039, 0.005 and 0.026, respectively). CONCLUSION: Besides colonic symptoms, IBS could cause generalized body discomfort and psychosocial problems. The IBS subgroups based on predominant bowel habits are helpful to identify clinical distinction of the IBS. QOL is significantly impaired in IBS patients. The Chinese version of the SF-36 health survey scales may be a useful measurement of IBS patients.     

Irritable bowel syndrome consulters in Zhejiang province: The symptoms pattern, predominant bowel habit subgroups and quality of life

AIM:To investigate the pattern of symptoms,predominantbowel habits and quality of life(QOL)by the Chinese versionof the SF-36 in irritable bowel syndrome(IBS)consulters inZhejiang province.METHODS:From January 2001 to January 2002,662 RomaⅡ criteria-positive IBS patients were enrolled bygastroenterologists in 10 hospitals from Digestive DiseaseCenter of Zhejiang(DDCZ).Patients were classified intoconstipation predominant IBS(IBS-C),diarrhea predominantIBS(IBS-D)and alternating constipation and diarrhea IBS(IBS-A)according to the predominant bowel habits.Allpatients were evaluated for the demographic checklists,IBSbowel symptoms,extra-colonic symptoms,and QOL byChinese version of the SF-36 questionnaire.RESULTS:(1) Besides abdominal pain,the predominantcolonic symptoms were in order of altered stool form,abnormalities of stool passage,abdominal distension andpassage of mucus in IBS patients.Also,IBS subjects reportedgeneralized body discomfort and psychosocial problemsincluding dyspeptic symptoms,poor appetite,heartburn,headache,back pain,difficulty with urination,fatigue,anxietyand depression.(2)IBS-C and IBS-A are more commonamong female patients,whereas male patients experiencedmore cases of IBS-D.In regards to the IBS symptoms,therewere significant differences among IBS subgroups.Abdominal pain(frequency≥2 days per week and duration≥1 hour per day)was frequent in IBS-A patients(P=0.010and 0.027,respectively),IBS-D patients more frequentlyexperienced the passage of mucus,dyspeptic symptomsand anxiety(P=-0.000,0.014 and 0.015,respectively).(3)IBS patients experienced significant impairment in QOL,decrements in QOL were most pronounced in vitality,generalhealth,mental health,and bodily pain.Compared with thegeneral population(adjusted for gender and age),IBS patientsscored significantly lower on all SF-scales(P<0.001),exceptfor physical function scale(P=0.149).(4)QOL was impairedin all subgroups,particularly in scales of vitality,general healthand mental health.Compared with IBS-D,QOL in IBS-C scoredsignificantly lower on physical function,role physical,generalhealth,role emotional,and mental health scales(P=0.037,0.040,0.039,0.005 and 0.026,respectively). CONCLUSION:Besides colonic symptoms,IBS could causegeneralized body discomfort and psychosocial problems.TheIBS subgroups based on predominant bowel habits arehelpful to identify clinical distinction of the IBS.QOL issignificantly impaired in IBS patients.The Chinese version ofthe SF-36 health survey scales may be a useful measurementof IBS patients.