抗生素对肠易激综合征的影响及机制探讨

作为20世纪伟大的医学发现之一，抗生素被广泛用于各种病原微生物的感染治疗,其中包括了肠易激综合征（IBS）。尽管临床实践以及多项临床研究均表明抗生素对IBS临床症状的改善有一定的作用，相关的指南、共识也推荐非吸收性抗生素利福昔明用于治疗非腹泻型IBS,但抗生素能否用于IBS的治疗指征尚未明确，长期运用抗生素引发的不良反应也令人担忧，不良反应与临床效益之间的平衡更难把握。然而，还有多项研究发现抗生素的使用对于IBS的发生起着促进作用。本文综述了近年来关于抗生素对IBS影响的研究，发现抗生素可能从降低肠道微生物多样性、损害上皮屏障功能、影响细胞因子产生等多个方面引发IBS，同时也从两个方面指出抗生素应用于IBS指征的不确定性，认为临床医生应当重视抗生素对IBS发病的影响，评估抗生素治疗IBS的利弊，合理、谨慎地使用抗生素，从而为抗生素在IBS的发生、发展以及临床应用方面提供一定的参考和借鉴。

The Exploration of the Effects and Mechanisms of Antibiotics on Irritable Bowel Syndrome

Antibiotics are one greatest medical discoveries in the 20th century, which are extensively used to treat a variety of pathogenic microbial infections, including irritable bowel syndrome (IBS) . Although antibiotics have proven to be partially effective in improving clinical symptoms of IBS by clinical practice and several clinical studies, and nonabsorbable rifaximin has been also recommended for treating IBS without diarrhea by relevant guidelines and consensuses, the indications for the use of antibiotics in IBS are not clear, and there are concerns about the adverse effects associated with long-term antibiotic use. Meanwhile, making the balance between adverse effects and clinical benefits is difficult. However, several studies have also found that antibiotic use contributes to the development of IBS. This paper reviews recent studies on the effects of antibiotics on IBS, and summarizes that antibiotics may trigger IBS in several ways, including reducing intestinal microbial diversity, impairing epithelial barrier function and affecting cytokine production. This paper also points out the uncertainty of the indications for antibiotic application in IBS from two aspects, and argues that clinicians should pay attention to the effects of antibiotics on the development of IBS, evaluate the pros and cons of antibiotic treatment for IBS, and use antibiotics rationally and cautiously. The purpose of this article is to provide some reference for explaining the pathogenesis of IBS induced by antibiotic treatment, and for clinical application of antibiotics in IBS.