食物不耐受IgG抗体检测与肠易激综合征关系的研究进展

肠易激综合征(irritable bowel syndrome,IBS)是一种严重影响罹患人群的生活质量并耗费大量医疗资源的慢性功能性肠病,其生理病理发病机制尚不明确,主要依靠症状学来诊断。早在2004年有国外学者报道食物不耐受与IBS有密切关系,近几年国内报道也相继证明这一观点,为IBS的诊断和治疗提供了新的思路和方向。本文就近年来食物不耐受IgG抗体检测与IBS关系作一概述,并对饮食个体化干预进行展望。     

肠易激综合征与食物不耐受相关性的研究现状

<正>肠易激综合征(irritable bowel syndrome,IBS)是临床常见的功能性胃肠病,其确切的发病机制仍不清楚。近年来食物不耐受(food intolerance,FI)在IBS中的作用受到广泛关注,根据特异性IgG抗体检测结果调整饮食方案,可有效改善患者不适症状,为IBS的诊断和治疗提供了新思路。本文在国内外研究的基础上,就IBS与FI相关性的研究现状作一综述。     

肠易激综合征患者食物特异性抗体IgE和IgG的检测

目的观察食物过敏后，机体的体液免疫情况，探讨食物过敏在肠易激综合征（IBS）发病中的作用和作用机制。方法对腹泻型IBS患者55例、便秘型IBS患者32例和健康对照组18例，采集外周静脉血，应用酶联免疫方法，进行14种食物抗原的特异性抗体IgE和IgG检测。结果腹泻型IBS血清食物特异性IgE抗体的阳性率43．64％，高于正常对照组，而便秘型IBS仅为15．63％，与正常对照差异无统计学意义。腹泻型IBS和便秘型IBS的IgE抗体阳性率存在差异。在食物特异性IgE抗体阳性的IBS患者中，多种食物阳性者48．28％。腹泻型IBS食物特异性IgG抗体的阳性率63．64％，便秘型IBS的阳性率为43．75％，两者均高于对照组，并且两组间比较差异无统计学意义。在食物特异性IgG抗体阳性的IBS中，多种食物阳性者51．02％。结论食物过敏介导的体液免疫反应异常在肠易激综合征的发病机制中，具有重要的作用。腹泻型肠易激综合征同时存在IgE和IgG介导的免疫异常反应，便秘型肠易激综合征只存在IgG介导的免疫异常反应。     

食物敏感与肠易激综合征研究进展

肠易激综合征(irritable bowel syndrome,IBS)是一种以腹痛或腹部不适伴排便习惯改变为特征的功能性胃肠病,其症状反复,严重地影响了患者的生活质量.研究发现,食物可引发或加重IBS患者的症状,其实质即食物过敏和食物不耐受,但具体的发病机制尚未得到肯定,目前包括细菌"代谢‘毒物’假说"、"免疫或炎症反应假说"、"物理或化学刺激假说"等.因此食物因素在IBS发病中的作用越来越受到重视,成为当前研究IBS病因的热点之一,本文将对食物敏感及食物引发IBS的可能机制、检测方法及干预措施的研究进展作一综述.     

肠易激综合征食物过敏患者血清IgG亚型检测及意义

目的探讨肠易激综合征（IBS）食物过敏患者IBS食物过敏血清IgG亚型变化,为其临床诊治提供依据。方法检测14例IBS食物过敏患者（观察组）和30例查体健康者（对照组）血清食物特异性IgG及其亚型。结果观察组血清总IgG及IgG2明显高于对照组;IgG1、IgG4明显低于对照组,P均〈0.05;两组IgG3水平比较无显著差异。结论 IBS食物过敏患者存在IgG介导的变态反应,参与食物过敏的IgG抗体可能为IgG1和IgG3。     

腹泻型肠易激综合征患者食物不耐受、症状指数及回盲部肥大细胞变化的相关性

目的:比较食物不耐受(food intolerance,FI)在腹泻型肠易激综合征患者(diarrhea-dominant irritable bowel syndrome,D-IBS)及健康人群中的存在情况,分析D-IBS患者食物不耐受严重程度、症状指数与回盲部肥大细胞数量变化之间的关系,以探讨食物不耐受在D-IBS发病中的意义及可能机制.方法:选取符合罗马Ⅲ诊断标准的D-IBS患者22例为病例组,无消化系症状的健康体检者21例为对照组,分别接受结肠镜检查.应用食物不耐受状况评价问卷对2组进行食物不耐受状况评分;用功能性肠病症状严重指数(functional bowel disorder severity index,FBDSI)和IBS病情尺度调查表(IBS symptomseverity scale,IBS-SSS)对病例组进行IBS症状严重程度评分.所有研究对象均接受结肠镜检查,在距回盲瓣4cm处取活检组织2块,采用甲苯胺蓝染色法计数黏膜肥大细胞数量,并与食物不耐受严重程度指数、IBS症状严重程度评分进行相关性分析.结果:D-IBS患者回盲部肠黏膜肥大细胞计数(4.68±0.55)个/高倍镜视野,健康对照组为(1.33±0.54)个/高倍镜视野,P<0.001,差异具有统计学意义;病例组食物不耐受存在情况明显高于对照组(P<0.05);食物不耐受严重程度与IBS症状严重程度指数间呈正相关(FBDSI:r=0.992,P<0.001;IBS-SSS:r=0.970,P<0.001);回盲部肥大细胞计数与I B S症状严重程度指数间呈正相关(FBDSI:r=0.957,P<0.001;IBS-SSS:r=0.985,P<0.001);食物不耐受严重程度与IBS患者回盲部肥大细胞计数间呈正相关(r=0.964,P<0.001),健康对照组中食物不耐受者回盲部肥大细胞计数明显高于无食物不耐受者(P<0.05).结论:D-IBS临床症状与肠道肥大细胞数量增多密切相关,食物抗原的刺激作用可能是D-IBS患者回盲部肥大细胞数目增多的原因之一;D-IBS患者食物不耐受存在情况普遍,食物不耐受可加重D-IBS患者肠道症状.     

遗传多态性与肠易激综合征发病的关系

肠易激综合征(irritable bowel syndrome, IBS)是最常见的一种功能性疾病,病因尚不清楚,先前的研究表明其发病机制与下列因素有关:胃肠动力学异常,内脏感觉异常,精神因素,神经递质和肠道菌群失衡,肠道感染以及食物不耐受等因素.而近来遗传因素和IBS发病关系的研究也进一步深入,本文综述遗传和相关基因多态性与IBS发病之间的联系.     

食物不耐受在肠易激综合征发病中作用的研究进展

目前多数研究认为食物不耐受（FI）是肠易激综合征（IBS）发病和症状加重的重要因素之一,IBS患者的FI与肠道低度炎症反应有关。可发酵的低聚糖、双糖、单糖和多元醇（FODMAPs）饮食可改善IBS症状,为探寻IBS的发病机制和治疗方案提供了新方向。本文就FI在IBS发病中作用的研究进展作一综述。     

色甘酸钠防治肠易激综合征患者的临床研究

近年国外研究发现，肠易激综合征（irritable bowel syndrome，IBS）患者某些食物IgG抗体增高，由此来剔除阳性食物，可改善症状及直肠顺应性。本研究检测IBS患者外周血中14种食物特异性IgG，并根据检测结果进行剔除→色甘酸钠预防→再次食用IgG阳性食物的循环干预治疗，观察治疗前、后患者症状和生活质量积分的改变，探讨食物过敏在IBS发病中的作用和机制，为探索新的IBS治疗途径提供依据。     

腹泻型肠易激综合征患者食物过敏的研究

肠易激综合征（IBS）是一种常见的以腹痛、腹部不适伴排便习惯改变为特征的功能性肠病，其病因和发病机制仍不清楚。IBS的症状常由饮食诱发或加重，由此推测食物过敏可能是IBS的原因之一。目前有关这方面的研究较少，我们采用食物过敏原皮肤试验和食物激发试验检测IBS患者的食物过敏情况，并观察食物剔除和脱敏治疗的疗效。     

剔除过敏食物治疗肠易激综合征的疗效观察

目的探讨依据食物特异性抗体IgG（SIgG）,剔除过敏食物治疗肠易激综合征（IBS）的疗效,进一步证实食物过敏在IBS发病中的作用。方法取腹泻型IBS（D—IBS）患者55例、便秘型IBS（C—IBS）患者32例和健康对照18例的静脉血,应用酶联免疫方法检测14种SIgG。对35例SIgG抗体升高的IBS患者,剔除过敏食物治疗2个月,观察治疗前后患者症状频率和程度的变化以及IBS专用生活质量量表（IBS QOL）积分的改变。结果D—IBS患者SIgG抗体的阳性率为63．6％（35／55）,C—IBS患者SIgG抗体的阳性率为43．8％（14／32）,二者均高于对照组。依据SIgG抗体剔除过敏食物治疗2个月,31．4％的患者症状完全缓解,34．3％的患者症状明显缓解。剔除过敏食物4周后,IBS患者的症状频率、严重程度积分分别由（3．79±1．58）次／周降至（1．67±0．70）次／周,3．18±1．46降至1．52±0．67;8周后,分别由（3．79±1．58）次／周降至（1．53±0．69）次／周,3．18±1．46降至1．45±0．66,差异均有统计学意义（P〈0．05）。IBS QOL 8个维度积分除挑食外其他积分和总体健康积分均比治疗前显著升高。结论IBS患者存在食物特异性IgG抗体介导的免疫异常反应,根据SIgG水平剔除过敏食物治疗IBS是有意义的。     

根据食物特异性IgG抗体剔除过敏食物治疗肠易激综合征

目的探讨食物过敏在肠易激综合征（IBS）发病中的作用和剔除过敏食物能否改善IBS的疾病严重度。方法按照罗马标准Ⅲ诊断纳入2007年~2009年IBS患者共241例,正常对照52例,收集基本资料,进行疾病严重度评分,ELISA法检测血清中14种食物过敏原特异性IgG抗体,按照测定结果剔除敏感食物,12周后重新进行疾病严重度评分。结果 241例IBS患者食物过敏原特异性IgG抗体阳性率前三位为鸡蛋21.16%,牛奶和西红柿5.81%,虾4.56%,52例正常对照组前三位为鸡蛋44.23%,牛奶11.53%,牛肉及鳕鱼1.92%。229例IBS患者剔除食物前疾病严重度评分分度,轻度占29.6%,中度占56.1%,重度占14.3%,剔除食物后,轻度占49.1%,中度占43.9%,重度占7.0%,剔除食物后与剔除食物前比较,有显著差异（P〈0.01）。剔除过敏食物后可以减轻腹泻型、便秘型和未分型组患者疾病严重度（P〈0.01）,而对混合型没有影响（P〉0.05）。结论食物过敏可能是IBS的发病原因之一,根据食物特异性IgG抗体检测,指导IBS患者剔除过敏食物,可以减轻患者疾病严重度,改善患者症状。     

Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial

BACKGROUND: Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies. AIMS: To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food. PATIENTS: A total of 150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies. METHODS: Primary outcome measures were change in IBS symptom severity and global rating scores. Non-colonic symptomatology, quality of life, and anxiety/depression were secondary outcomes. Intention to treat analysis was undertaken using a generalised linear model. RESULTS: After 12 weeks, the true diet resulted in a 10% greater reduction in symptom score than the sham diet (mean difference 39 (95% confidence intervals (CI) 5-72); p = 0.024) with this value increasing to 26% in fully compliant patients (difference 98 (95% CI 52-144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24% greater deterioration in symptoms in those on the true diet (difference 52 (95% CI 18-88); p = 0.003). CONCLUSION: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.     

慢性腹泻患者食物特异性IgG抗体的检测

目的探讨食物不耐受与慢性腹泻发病的相关性。方法采用ELISA半定量法检测82例慢性腹泻患者血清中14种食物的水平。结果慢性腹泻患者所测食物中以蟹的IgG抗体阳性率（48．8％）最高，其次为虾（41．5％）、蛋清／蛋黄（35．4％）和牛奶（23．2％），再次为鳕鱼（19．5％）和小麦（17．1％）；≤50岁年龄组腹泻患者食物IgG抗体阳性率明显高于〉50岁年龄组（P〈0．05）；慢性腹泻患者食物特异性IgG抗体检测的总阳性率为89．0％（73／82），其中1种食物IgG抗体阳性率为30．5％（25／82），2种以上者为58．5％（48／82）。结论食物不耐受是慢性腹泻的致病因素之一，检测食物特异性IgG抗体对于了解慢性腹泻的发病机制和指导临床治疗具有积极的意义。     

Food allergy in irritable bowel syndrome: new facts and old fallacies

The notion of food allergy in irritable bowel syndrome (IBS) is not new. However, recent evidence suggests significant reduction in IBS symptom severity in patients on elimination diets, provided that dietary elimination is based on foods against which the individual had raised IgG antibodies. These findings should encourage studies dissecting the mechanisms responsible for IgG production against dietary antigens and their putative role in IBS     

Dietary treatment of the irritable bowel syndrome

Opinion statement Most patients with functional gastrointestinal disorders report that food ingestion appears to exacerbate their symptoms and consequently conclude that they have some form of gastrointestinal food allergy or intolerance. Dietary management of functional gastrointestinal conditions is an attractive therapeutic option for the patient and physician alike because it is safe and economical and empowers the patient to help themselves. However, in practice, dietary manipulation frequently yields rather disappointing results. Exclusion diets can be helpful, but are labor intensive and occasionally can be very restrictive. Laboratory testing for immunoglobulin E food antibodies usually is not helpful, except in a small subgroup of patients with diarrhea, predominant irritable bowel syndrome (IBS), and atopy. There is some preliminary evidence to suggest that elimination diets based on immunoglobulin G food antibody testing may possibly have therapeutic potential in IBS, but this requires confirmation.     

Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome

OBJECTIVE: Dietary modification improves symptoms in irritable bowel syndrome (IBS). Identification of offending foods by dietary elimination/re-challenge is cumbersome. IgG4 antibodies to common food antigens are elevated in IBS. The aim of this article was to evaluate the effect of exclusion diet based on IgG4 titres on IBS symptoms and rectal sensitivity and compliance. MATERIALS AND METHODS: The study comprised 25 patients with IBS (3 M, 22 F, mean age 43 years, Rome II criteria). IgG4 titres to 16 foods (milk, eggs, cheese, wheat, rice, potatoes, chicken, beef, pork, lamb, soya bean, fish, shrimps, yeast, tomatoes and peanuts) were measured. Foods with titres >250 microg/l were excluded for 6 months. Symptom severity was assessed with a previously validated questionnaire at baseline, at 3 months and at 6 months. Rectal compliance and sensitivity were measured in 12 patients at baseline and at 6 months. RESULTS: IgG4 antibodies to milk, eggs, wheat, beef, pork and lamb were commonly elevated. Significant improvement was reported in pain severity (p < 0.001), pain frequency (p = 0.034), bloating severity (p = 0.001), satisfaction with bowel habits (p = 0.004) and effect of IBS on life in general (p = 0.008) at 3 months. Symptom improvement was maintained at 6 months. Rectal compliance was significantly increased (p = 0.011) at 6 months but the thresholds for urge to defecate/discomfort were unchanged. CONCLUSIONS: Food-specific IgG4 antibody-guided exclusion diet improves symptoms in IBS and is associated with an improvement in rectal compliance.     

Food-specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome

INTRODUCTION: Food hypersensitivity is a common perception among irritable bowel syndrome (IBS) patients. Data from dietary elimination and food challenge studies support an etiopathological role of diet in IBS, but there are no well-established tests to identify food hypersensitivity. AIM: To compare IgG4 and IgE titers to common food antigens in IBS and controls. METHOD: One hundred and eight IBS [52 diarrhea-predominant (D-IBS); 32 constipation-predominant (C-IBS); 24 alternating (Alt-IBS)], and 43 controls were included in the study. IgG4 and IgE titers and skin prick testing (SPT) to 16 common foods including milk, eggs, cheese, wheat, rice, potatoes, chicken, beef, pork, lamb, fish, shrimps, soya bean, yeast, tomatoes, and peanuts were measured. RESULTS: IBS had significantly higher IgG4 titers (mug/L) to wheat (395 IQR +/- 1,011 vs 0 IQR +/- 285, p < 0.001), beef (1,079 IQR +/- 930 vs 617 IQR +/- 435, p < 0.001), pork (481 IQR +/- 379 vs 258 IQR +/- 496, p < 0.001), and lamb (241 IQR +/- 460 vs 167 IQR +/- 232, p= 0.009) compared to controls. These differences were maintained across all three subgroups. The antibody titers to potatoes, rice, fish, chicken, yeast, tomato, and shrimps were not significantly different. No significant difference in IgE titers was observed between IBS and controls. SPT was positive for only a single antigen in 5 of 56 patients tested with the same panel of foods. No correlation was seen between the pattern of elevated IgG4 antibody titers and patients' symptoms. CONCLUSION: Serum IgG4 antibodies to common foods like wheat, beef, pork, and lamb are elevated in IBS patients. In keeping with the observation in other atopic conditions, this finding suggests the possibility of a similar pathophysiological role for IgG4 antibodies in IBS.     

饮食在肠易激综合征症状发作和治疗中的作用

流行病学研究资料提示,肠易激综合征(irritable bowel syndrome,IBS)患者的症状发作与饮食有关.饮食影响IBS症状的机制仍未完全阐明,可能与食物的促动力和促胃肠激素分泌作用、食物不耐受、食物过敏和不良进食习惯等有关.有证据表明采用食物剔除和添加膳食纤维、益生菌和益生元等特殊食物成分的饮食调整治疗能缓解IBS的症状.本文从IBS与食物有关的表现、饮食影响IBS症状的原因和机制、饮食对IBS治疗的作用3个方面总结了相关研究的进展.