腹泻型肠易激综合征患者内脏敏感性、肠屏障功能及自主神经功能的评价

目的：评价腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome，IBS-D)患者的内脏敏感性、肠屏障功能和自主神经功能(autonomic nerve function，ANF)，探索它们在IBS-D病理生理学中的作用。方法：以2015年10月至2016年3月就诊于中日友好医院消化内科的46例IBS-D患者(IBS-D组)和20例健康志愿者(对照组)为研究对象，采用问卷评估其临床及精神心理症状，并检测内脏敏感性、肠屏障功能及ANF，比较两组上述各指标的差异，并分析IBS-D组中各指标间的相关性。结果：IBS-D组的病情尺度调查表(IBS symptom severity scale，IBS-SSS)、汉密尔顿焦虑量表(Hamilton anxiety scale，HAMA)、汉密尔顿抑郁量表(Hamilton depression scale，HAMD)和内脏敏感指数(visceralsensitivity index，VSI)评分均显著高于对照组(P<0.01)。内脏敏感性检测中，IBS-D组对直肠扩张刺激的最大耐受阈值显著低于对照组(P<0.01)，初始感觉阈值和持续排便阈值两组差异无统计学意义(P>0.05)。肠屏障功能血清标志物二胺氧化酶(diamine oxidase，DAO)和D-乳酸在IBS-D组中均显著升高(均P<0.05)。IBS-D组的ANF总分和副交感计分以及两者的异常比例均显著高于对照组(均P<0.05)。在IBS-D组各指标相关性分析中，HAMA，VSI和血清DAO与IBSSSS呈显著正相关(分别r=0.528，0.575，0.507；P<0.01)，3个内脏感觉阈值均与IBS-SSS呈显著负相关(分别r=–0.636，–0.476，–0.697，P<0.01)；与内脏感觉阈值呈显著负相关的指标除IBS-SSS外，还有HAMA，HAMD，VSI和血清DAO(均P<0.05)；ANF与其他指标间未发现关联。结论：IBS-D患者存在精神心理异常、内脏高敏感、肠屏障受损和以副交感神经功能异常为主的ANF失调，前三者均与病情程度相关，可能在IBS-D病理生理学中发挥了重要作用。

Visceral sensitivity,gut barrier function and autonomicnerve function in patients with diarrhea-predominantirritable bowel syndrome

Objective: To evaluate visceral sensitivity, gut barrier function and autonomic nerve function(ANF) in patients with diarrhea-predominant irritable bowel syndrome (IBS-D), and to exploretheir roles in IBS-D pathophysiology.Methods: A total of 46 IBS-D patients (IBS-D group) were selected from the Department ofGastroenterology of China-Japan Friendship Hospital from October 2015 to March 2016, and 20healthy volunteer were served as a control group (HC group). Clinical and psychological symptomswere evaluated by questionnaire, and visceral sensitivity to rectal balloon distention, gut barrierfunction and autonomic nerve function (ANF) were examined. The difference in the abovementionedindexes were compared between the 2 groups, and the correlations in the parameterswere analyzed in the IBS-D group.Results: The scores of IBS symptom severity scale (IBS-SSS), Hamilton anxiety scale (HAMA),Hamilton depression scale (HAMD) and visceral sensitivity index (VSI) were significantly higherin the IBS-D group than those in the HC group (P<0.01). In the visceral sensitivity test, maximumtolerable threshold in the IBS-D group was significantly decreased compared to that in the HCgroup (P<0.01); there was no significant difference in first sensation threshold and defecatingsensation threshold between the two groups (P>0.05). As gut barrier function markers, the serumdiamine oxidase (DAO) and d-lactate were significantly increased in the IBS-D group (P<0.05). InANF test, the total score and parasympathetic score as well as the proportion of abnormal scores inthe IBS-D group were significantly higher than those in the HC group (P<0.05). In IBS-D group,the HAMA, VSI and serum DAO were positively correlated with IBS-SSS (r=0.528, 0.575, 0.507;P<0.01), while the 3 visceral sensitivity thresholds were negatively correlated with IBS-SSS (r=–0.636, –0.476, –0.697; P<0.01); in addition to the IBS-SSS, the HAMA, HAMD, VSI and serumDAO were also significant negatively correlated with the visceral sensitivity thresholds (all P<0.05);no significant correlations were found between the ANF and the other parameters.Conclusion: IBS-D patients show psychological symptoms, visceral hypersensitivity, impairedgut barrier function and abnormal ANF characterized by parasympathetic dysfunction; theformer 3 factors are all associated with disease severity, and thus may play vital roles in IBS-Dpathophysiology.