基于肺与大肠相表里理论探讨炎症性肠病与肠易激综合征患者肺功能改变的差异

目的通过比较炎症性肠病(IBD)患者、腹泻型肠易激综合征(IBS)患者、健康人群肺功能指标及肺部表现的差异,总结IBD患者肺支气管病损的发病规律,寻找中医"肺与大肠相表里"的临床依据。方法选取符合纳入标准的IBD患者219例(IBD组),其中溃疡性结肠炎(UC)183例,克罗恩病(CD)36例。腹泻型IBS患者30例(IBS组),同时选择20例健康志愿者作为对照组。采集一般资料和肺部症状,检测血清肝肾功能,并行胸部X线及肺功能检查。结果 IBD组患者中,肺功能异常占71.2%,胸片异常占19.6%,咳嗽、气短等肺部症状占18.7%,复发性口腔溃疡等其他除肺以外的肠外表现占30.1%;IBS组患者中,肺功能异常占33.3%,肺部症状占3.3%;对照组肺功能异常占20%,无肺部伴随症状。CD患者肺活量(VC)、一秒率(FEV 1.0%)、最大中期呼气流速(MMEF)、75%肺活量时的最大呼气流速(FEF 75%)、一氧化碳弥散量(DLCO)及肺总量(TLC)指数较腹泻型IBS患者及健康志愿者明显下降;UC患者FEV 1.0%、FEF 75%、MMEF及DLCO指数较腹泻型IBS患者及健康志愿者明显下降。结论与腹泻型IBS患者及健康志愿者相比,IBD患者更容易出现肺功能异常。CD患者肺功能损害以阻塞型通气障碍和限制型通气障碍为主。UC患者的肺功能损害表现为阻塞型或混合型通气障碍。IBD患者的肺部损害远远高于其他肠外表现,从而证明了肺与大肠间病损的特异性。

Differences in Lung Dysfunction between Inflammatory Bowel Disease and Irritable Bowel Syndrome Based on Interaction of Lung and Large Intestine

Objective To compare the differences in lung function indexes and pulmonary manifestations among the patients of inflammatory bowel disease（ IBD） and irritable bowel syndrome（ IBS） as well as healthy group so as to sum up the occurrence rule of bronchial damage in IBD patients and seek the clinical evidence on＂interaction of lung and large intestine＂. Methods Two hundred and nineteen IBD patients were in accordance with the inclusive criteria,of them,183 cases had ulcerative colitis and 36 cases Crohn＇s disease（ CD）. Thirty patients were collected,suffered from diarrhea IBS,and at same time 20 healthy volunteers were chosen in the control group. The general data and lung symptoms were collected. Serum liver and kidney functions were detected. X- ray test of chest and lung function examinations were given. Results Among IBD patients,71. 2% of them had lung dysfunction,19. 6% of them had abnormal indications on the chest X- ray film,18. 7% of them had lung symptoms such as cough and short breath and 30. 1% of them had parenteral symptoms except lung such as recurrent dental ulcer. Among those diarrhea IBS patients, 33. 3% of them had lung dysfunction,3. 3% of them had lung symptoms. Among the healthy volunteers,20% of them had lung dysfunction and no case had lung symptom. The results of VC,FEV 1. 0%,MMEF,FEF 75%,DLCO and TLC in CD patients were reduced apparently as compared with those diarrhea IBS patients and healthy volunteers. The results of FEV 1. 0%,FEF 75%,MMEF and DLCO in UC patients were reduced apparently as compared with those diarrhea IBS patients and healthy volunteers. Conclusion Compared with diarrhea IBS patients and healthy volunteers,IBD patients have lung dysfunction more likely. The lung damage in CD patients is obstructive ventilation impairment and restrictive ventilation impairment and that in UC patient is obstructive or mixed ventilation impairment; and that in IBD patients is much serious than the other parenteral manifestation. All of those prove the specificity of the