肠易激综合征患者脑部痛觉功能区域的变化

目的应用血氧水平依赖性功能性磁共振(BOLD fMRI)技术研究肠易激综合征(irritablebowelsyndrome ,IBS)患者颅内痛觉功能区的变化及临床意义并比较与正常人的差异。方法2 0 0 2年1月～2 0 0 4年2月期间,参照罗马II诊断标准纳入67例肠易激综合征患者和10例正常志愿者,其中腹泻型肠易激综合征44例,男19例,女2 5例。年龄3 4～73岁,平均年龄5 3 0 7±8 44岁。便秘型肠易激综合征2 3例,其中男12例,女11例,年龄2 1～74岁,平均年龄46 2 2±14 64岁。直肠注气试验记录感觉阈值和感觉评分;功能性磁共振(fMRI)分析直肠扩张3 0ml、60ml、90ml和12 0ml时颅内痛觉功能区扣带前皮质(ACC)、脑岛皮质(IC)、额前皮质(PFC)及丘脑(THAL)的激活面积和强度。结果腹泻型IBS患者排便急迫和疼痛阈值显著低于便秘型患者和正常志愿者(P <0 0 5 ) ;腹泻型IBS患者在直肠注气90ml和12 0ml时视觉模拟评分(VAS)显著高于正常志愿者(P <0 0 5 ) ;便秘型IBS患者直肠扩张12 0ml时额前皮质、右侧丘脑兴奋面积较正常对照组显著增高(P <0 0 5 ) ,腹泻型IBS患者直肠扩张12 0ml时右侧脑岛皮质、额前皮质和右侧丘脑的兴奋面积较正常对照组显著增高(P <0 0 5 ) ;所有IBS患者直肠扩张90ml时脑岛皮质、直肠扩张12 0ml时脑岛皮质、额前皮质和丘脑     

肠易激综合征患者内脏高敏感性的机制研究

目的检测肠易激综合征(IBS)患者的内脏感觉及其结肠黏膜肥大细胞(MC)、P物质(SP)和血管活性肠肽(VIP)的改变,探讨MC、SP、VIP对IBS患者内脏高敏感性的作用及其机制.方法黏膜标本取自19例正常人和22例腹泻型IBS(D-IBS)、20例便秘型IBS(C-IBS)患者回肠末端、回盲部、升结肠、乙状结肠,应用特殊组织化学染色法、免疫组织化学染色法分别对MC、SP和VIP免疫反应阳性神经纤维进行染色,应用彩色病理图像分析软件进行分析,电镜观察MC及其毗邻结构;应用电子气压泵及灌注导管测压仪检测上述患者肛门直肠压力、直肠对容量刺激的感觉及直肠顺应性.结果IBS组回肠末端、回盲部、升结肠MC明显增多,MC显著变异(P＜0.01);IBS组结肠黏膜SP、VIP免疫反应阳性神经纤维较正常对照组增多、增粗、阳性强度增强(P＜0.01);IBS组SP、VIP免疫反应阳性纤维的阳性强度均值、面积与MC的密度、面积密切相关(r=0.3860～0.6632,P＜0.01、P＜0.05),并可观察到MC与无髓神经末梢及浆细胞等内分泌细胞毗邻或密切接触;IBS组肛门直肠括约肌的静息压、收缩压、松弛压与正常对照组相似(P＞0.05),感觉阈值、排便阈值、疼痛阈值明显低于正常对照组(P＜0.01),直肠顺应性降低(P＜0.01),向直肠内注气20或40 ml后均可引起直肠肛门抑制性反射.结论MC、SP、VIP在IBS的病理生理机制中可能起关键性作用,MC活性、SP、VIP免疫反应阳性神经纤维可能与IBS以内脏感觉及动力变化为特征的内脏高敏感性相关联.     

肠易激综合征患者肛门直肠感觉阈值和动力学的改变

采用PC Polygraf HR高分辨多道胃肠功能测定仪,检测42例肠易激综合征(IBS)患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值等指标,并与15例健康人做对照.结果发现IBS的直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与对照组无显著性差异(P＞0.05),而初始感觉阈值、疼痛阈值、排便阈值腹泻组低于正常对照组(P＜0.05),便秘组高于正常对照组(P＜0.05).排便时IBS便秘组患者的肛管松弛压高于正常对照组(P＜0.05).提示IBS患者排便功能和直肠感觉功能存在异常.     

肠康方对肠易激综合征内脏高敏感模型大鼠的作用

[目的]探讨肠康方对肠易激综合征(IBS)内脏高敏感模型大鼠的作用.[方法]制备肠易激综合征内脏高敏感模型,将72只Sprague-Dawley大鼠随机分为6组,即模型组,空白对照组,阳性药物对照组,肠康方高、中、低剂量组.在造模第60天开始灌胃给药或0.9％氯化钠溶液共10d,干预后通过腹肌回缩反射(AWR)半定量评分测定大鼠内脏敏感性.[结果]不同压力下模型组AWR评分显著高于空白对照组,肠康方高、中、低剂量组治疗后AWR评分均显著低于模型组(P＜0.05或P＜0.01).[结论]肠康方可通过改善内脏高敏感治疗IBS.     

miR-196b在溃疡性结肠炎缓解期肠易激样综合征肠黏膜中表达的意义

[目的]:研究溃疡性结肠炎(ulcerative colitis,UC)缓解期肠易激样综合征(IBLS)患者肠黏膜组织中miR-196b的表达水平,探讨其在溃疡性结肠炎缓解期肠易激样综合征[IBS(+)UC]中的意义。[方法]选取IBS(+)UC患者16例,并同时配对UC缓解期无肠易激样综合征[IBS(-)UC]患者及肠易激样综合征-腹泻型(IBS-D)患者各16例,采用qRT-PCR方法检测直肠黏膜组织中miR-196b的表达水平。[结果]IBS(+)UC患者直肠黏膜组织中miR-196b正常表达,水平为0.58±0.09,IBS(-)UC组直肠黏膜组织中miR-196b低表达,水平为0.41±0.07。2组比较差异有统计学意义(P0.05);IBS-D组miR-196b高表达,水平为0.64±0.11,与IBS(+)UC组比较差异无统计学意义(P0.05);与IBS(-)UC组比较,差异有统计学意义(P0.05)。[结论]直肠黏膜组织中miR-196b水平在IBS(+)UC表达上调,可以作为区分IBS(-)UC的关键指标。     

肠易激综合征便秘型和功能性便秘结、直肠肛门动力学研究

目的 研究肠易激综合征(IBS)便秘型和功能性便秘患者结肠、直肠动力,直肠感觉功能.方法 对IBS便秘型患者52例和功能性便秘患者48例进行肛门直肠测压检查,并做结肠传输试验.同时选择正常健康人作对照组.结果 IBS便秘型组和功能性便秘组与对照组间直肠静息压、肛管静息压和肛门括约肌最大缩榨压比较均未见明显差异.IBS便秘型组初感阈值及排便阈值(75.00±34.04 ml,117.31±37.60 ml)较正常对照(97.14±20.54 ml,138.57±19.94 ml)明显降低.功能性便秘组排便阈值及最大耐受阈值(187.92 ±68.62 ml,252.5±93.40ml)较正常对照组(138.57±19.94 ml,181.43±18.34 ml)明显升高.IBS便秘型组各项感觉阈值较功能性便秘组均明显降低.功能性便秘组较IBS便秘型组患者结肠传输试验符合出口梗阻的比例高,但无统计学差异.结论 IBS便秘型直肠感觉过敏,功能性便秘直肠感觉迟钝.     

肠易激综合征直肠感知功能和胆囊收缩功能的研究

目的 探讨肠易激综合征(irritable bowel syndrome,IBS)是否存在内脏感知和胆囊收缩功能异常.方法 选择2003年2月至2004年2月在中国医科大学附属第一医院消化内科就诊,诊断符合RomeⅡ标准的IBS患者76例,按是否有腹痛症状分为腹痛组40例,非腹痛组36例,按症状类型分为腹泻组18例、便秘组30例、腹泻与便秘交替组28例;以30名健康志愿者为对照组.直肠初始感受容积和紧迫感阈值容积的测定采用直肠水囊容积试验.用实时超声图像检测空腹胆囊和进食后不同时间的胆囊客积.结果 与对照组比较,IBS患者直肠容积的初始感受容积和紧迫感阈值容积明显降低.腹泻组、便秘组和腹泻便秘交替组IBS初始感受容积均低于对照组(P＜0.01或P＜0.05),腹痛组IBS患者的初始感受容积和紧迫感阈值容积明显低于非腹痛组(P＜0.01).IBS患者空腹胆囊容积、进餐后40min、60min和120min胆囊残余容量均高于对照组(均P＜0.01).IBS患者胆囊最大排空百分比显著大于对照组,最大收缩时间显著短于对照组(均P＜0.01).结论 IBS患者内脏神经敏感性增加,可能是IBS发病的主要机制之一.IBS患者可能存在胆囊收缩功能异常.     

感染后肠易激综合征与溃疡性结肠炎缓解期患者肠黏膜细胞因子表达的相关性

目的:探讨感染后肠易激综合征(PI-IBS)与溃疡性结肠炎(UC)缓解期患者结肠黏膜细胞因子表达的相关性.方法:PI-IBS组26例,UC组45例及对照组30例,结肠镜下活检降结肠和直肠黏膜标本,采用免疫组化SABC法检测其肠黏膜P物质(SP)与IL-2,IFN-γ的表达情况.结果:PI-IBS组降结肠和直肠黏膜IFN-γ和IL-2阳性率表达、SP强度均值和面积高于对照组(IFN-γ:χ2=13.781,14.012,P＜0.01;IL-2:χ2=13.890,13.931,P＜0.01;SP强度:t=3.623,3.722,P＜0.01;SP面积:t=3.454,3.561,P＜0.01),但与UC组患者无显著差异.降结肠、直肠黏膜IFN-γ,IL-2阳性表达的PI-IBS患者,SP强度均值(t=2.202,2.220,P＜0.05)、面积高于对照组(t=2.301,2.252,P＜0.05),与UC组患者也无显著差异.结论:PI-IBS和UC缓解期患者细胞因子表达无显著差异.从神经-免疫机制上分析认为IBS与炎症性肠病(IBD)之间存在某种相关性,IBS可能是轻微的IBD.     

中西医结合治疗肠易激综合征40例

[目的]观察马来酸曲美布汀(商品名:双迪)联合四逆散加减治疗肠易激综合征(IBS)的疗效.[方法]60例IBS患者随机分为2组,治疗组40例予马来酸曲美布汀联合四逆散加减治疗;对照组20例单用马来酸曲美布汀治疗.[结果]治疗组总有效率92.5%,优于对照组的85.0%(P＜0.05).治疗组缓解腹痛和便秘症状亦优于对照组(均P＜0.05).[结论]马来酸曲美布汀联合四逆散加减治疗IBS疗效较为理想.     

健脾止泄方联合凝结芽孢杆菌活菌片对腹泻型IBS患者血清NPY水平、IBS症状严重程度积分及直肠最大耐受阈值的影响

[目的]观察健脾止泄方联合凝结芽孢杆菌活菌片对腹泻型肠易激综合征(IBS)患者血清神经肽Y(NPY)水平、IBS症状严重程度积分及直肠最大耐受阈值的影响。[方法]依据自愿接受治疗方案的不同将2017年12月～2018年12月在我院就诊的94例腹泻型IBS患者分为2组,对照组48例接受凝结芽孢杆菌活菌片治疗,研究组46例在对照组基础上联合使用健脾止泄方。进行疗效评价,测定血清5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)、P物质(SP)、NPY水平,统计IBS症状严重程度积分,并对直肠最大耐受阈值、双歧杆菌/肠杆菌值进行比较。[结果]研究组总有效率明显高于对照组(P0.05);治疗后2组血清5-HT、CGRP、SP、NPY水平与治疗前相比均明显降低(P0.05),且治疗后研究组血清5-HT、CGRP、SP、NPY水平均明显低于对照组(P0.05);治疗后2组IBS症状严重程度积分与治疗前相比均明显下降(P0.05),且治疗后研究组IBS症状严重程度积分明显低于对照组(P0.05);治疗后2组直肠最大耐受阈值、双歧杆菌/肠杆菌值与治疗前相比均明显增大(P0.05),且治疗后研究组直肠最大耐受阈值、双歧杆菌/肠杆菌值明显大于对照组(P0.05)。[结论]腹泻型IBS临床治疗应用健脾止泄方与凝结芽孢杆菌活菌片联合治疗方案,有利于增进疗效,合理调节血清5-HT、CGRP、SP、NPY水平,IBS症状严重程度积分下降明显,且直肠最大耐受阈值、双歧杆菌/肠杆菌值改善明显。     

Functional brain imaging in irritable bowel syndrome with rectal balloon－distention by using fMRI

AIM: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls. METHODS: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects. RESULTS: Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37), prefrontal cortex (37/37), and thalamus (35/37) in most cases. At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls. CONCLUSION: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.     

安肠汤治疗对肝郁脾虚证腹泻型肠易激综合征患者症状体征及生活质量的影响

目的:探究安肠汤治疗对肝郁脾虚证腹泻型肠易激综合征(IBS)患者症状体征及生活质量的影响。方法:将2019年6月—2020年6月我院消化科就诊的92例肝郁脾虚证腹泻型IBS患者作为受试对象,随机数字表法分为观察组及对照组,各46例,均接受低FODMAPs饮食结构并口服匹维溴铵片治疗,观察组在其基础上给予安肠汤治疗。比较2组临床疗效,并记录其治疗前、治疗8周后的症状体征积分[中医证候积分、肠易激综合征症状严重程度问卷(IBS-SSS)评分]、炎性因子[白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]、直肠动力[肛管静息压(ARP)、肛门括约肌最大收缩压(AMCP)、直肠静息压(RRP)、直肠最低敏感量]及生活质量[肠易激综合征患者生活质量量表(IBS-QOL)]变化。结果:治疗8周后,观察组总有效率为91.30%,对照组为73.91%,观察组优于对照组(P<0.05);治疗后观察组中医证候总积分、IBS-SSS评分、IL-1β、TNF-α、CRP水平、IBS-QOL各维度评分明显低于对照组(P<0.05),ARP、直肠最低敏感量明显高于对...     

肝郁脾虚型肠易激综合征与5-羟色胺转运体基因多态性的关系

[目的]探讨肝郁脾虚型肠易激综合征（IBS）与5-羟色胺转运体（SERT）基因多态性的关系。[方法]用多聚酶链式反应技术（PCR）对50例肝郁脾虚型IBS患者与96例健康对照者SERT基因的启动子区（5-HTTLPER）和内含子2可变数目串联重复序列（VNTRs）多态性进行研究。[结果]肝郁脾虚型组5-HTTLPR基因频率分布是S／S 40．0％，L／S54．0％，L／L11．1％。健康对照组的分布频率是S／S57．3％，L／S35．4％，L／L7．3％。2组之间比较差异无统计学意义（P〉0．05），但肝郁脾虚型组的L／S基因频率比对照组明显升高（P〈0．05）。2组VNTRs区的多态性比较差异无统计学意义（P〉0．05）。[结论]拥有L／S基因型可能是肝郁脾虚型IBS的多个易患因素之一。     

白芍总苷对肠易激综合征大鼠Th1/Th2表达失衡的影响

[目的]研究白芍总苷(TGP)对肠易激综合征(IBS)大鼠Th1/Th2细胞因子的影响。[方法]实验动物按随机数字表法分为5组:模型组、TGP高剂量组、TGP低剂量组、阳性对照组、正常组;除正常组外,其他各组采用免疫诱导联合心理应激法建立IBS大鼠模型。观察各组大鼠血清及结肠黏膜Th1细胞因子白细胞介素(IL)-2、Th2细胞因子IL-5水平的变化。[结果]与正常组比较,模型组大鼠血清、结肠黏膜IL-2水平明显增高(P<0.01),IL-5水平降低(P<0.05);与模型组比较,TGP高、低剂量组及阳性对照组血清、结肠黏膜IL-2水平明显降低(P<0.05,0.01),IL-5水平增高(P<0.05)。[结论]IBS大鼠血清、结肠黏膜Th1/Th2表达失衡,TGP有调节平衡的作用。     

A preliminary study of melatonin in irritable bowel syndrome

BACKGROUND AND AIMS: Melatonin is involved in the regulation of gut motility and sensation. We aimed to determine if melatonin was effective in improving bowel symptoms, extracolonic symptoms, and quality of life (QOL) in irritable bowel syndrome (IBS) patients. METHODS: Eighteen patients (aged 18 to 65 y; 6 females) were randomly assigned to receive either melatonin 3 mg (n=9) or matching placebo (n=9) at bed time for 8 weeks. The overall IBS scores, extracolonic IBS scores, QOL scores were assessed at 2, 4, 6, and 8 weeks during treatment and at 16, 24, and 48 weeks during follow up. RESULTS: Compared with placebo, melatonin taken for 8 weeks significantly improved overall IBS score (45% vs. 16.66%, P<0.05). The posttreatment overall extracolonic IBS score was significantly lower (49.16% to 13.88%, P<0.05) when compared with placebo group. The overall improvement in QOL score was 43.63% in melatonin group and 14.64% in placebo group that is statistically significant. CONCLUSIONS: The result of this study showed that melatonin has some beneficial role in IBS. Further studies using large number of patients may provide a definite answer.     

便秘型肠易激综合征患者直肠肛管压力的改变与焦虑/抑郁情绪测定评分的临床意义

[目的]探讨便秘型肠易激综合征(IBS-C)患者直肠肛管压力的变化及其与焦虑/抑郁情绪测定评分的关系与意义。[方法]选择确诊为IBS-C的患者70例为试验组、健康志愿者24例作为对照组,采用肛管直肠测定仪进行动力学检查,并采用综合医院焦虑/抑郁情绪测定表进行心理状况评估,比较2组直肠肛管的压力和情绪测定评分的差异。[结果]试验组患者直肠初始感觉阈值、初始排便感觉阈值、直肠最大容量感觉阈值均高于对照组(P0.05);试验组直肠肛门抑制反射阈值和肛管静息压高于对照组,但2组比较差异无统计学意义(P0.05);试验组肛管最大自主收缩压低于对照组、焦虑评分与抑郁评分显著高于对照组(均P0.05)。[结论]IBS-C患者存在明显的直肠感觉功能的障碍和盆底肌协调运动障碍,且存在焦虑抑郁症状,为临床诊治提供了依据。     

Role of loperamide and placebo in management of irritable bowel syndrome (IBS)

Symptom scores, stool data, and the transit of a standard, solid meal were measured in 28 patients with irritable bowel syndrome (IBS) during baseline conditions and after five weeks of treatment with placebo and loperamide, given as a flexible dosage regime in the form of a double-blind, cross-over trial. All patients had undergone a comprehensive series of diagnostic investigations and had failed to respond to dietary supplementation with coarse wheat bran (10–30 g daily). Loperamide treatment accelerated gastric emptying, compared with placebo (1.2±0.1 vs 1.5±0.1 hr; P<0.001) and delayed both small bowel (6.2±0.3 vs 4.3±0.3 hr P<0.001) and whole gut transit (56±5 vs 42±4 hr; P<0.01). Eighteen patients said they felt better taking loperamide compared with placebo and, at follow up, 15 of these patients remained satisfied with the effects of the drug. Most symptoms improved significantly on placebo compared with the baseline period, but three of these [diarrhea (P<0.01), urgency (P<0.01) and borborygmi (P<0.05)] showed a further significant improvement on loperamide. Improvement in diarrhea was not associated with any change in stool weight but was associated with reductions in stool frequency (P<0.001), passage of unformed stools (P<0.01), and incidence of urgency (P<0.001). Urgency was the only symptom that was significantly more common in the success group, compared with the group who did not feel better on loperamide.The study was supported by a project grant from the Medical Research Council. Dr. Cann was funded by Janssen Pharmaceuticals (UK), Marlow, Buckinghamshire.     

Vitamin D3 Induced Decrease in IL-17 and Malondialdehyde,and Increase in IL-10 and Total Antioxidant Capacity Levels in Patients with Irritable Bowel Syndrome

Background: Given the variations in clinical presentation and physiopathological mechanisms in irritable bowel syndrome (IBS) subtypes, it is an acknowledged fact that the response to treatments can be disparate. Objective: To assess the effect of vitamin D on inflammatory cytokines (IL-17, IL-10, TNF-α), and biomarkers of oxidative stress (total antioxidant capacity (TAC), and malondialdehyde (MDA)) among IBS patients. Methods: A double-blind, randomized, placebo-controlled 6-month intervention study was carried out on 90 IBS patients (85 were analyzed), as defined by the Rome III criteria. Study participants were randomly assigned to receive either 50,000 IU vitamin D3 or a placebo fortnightly. Results: Vitamin D supplementation significantly reduced the IL-17 and MDA serum levels (P<0.05) and observably increased the TAC and IL-10 serum levels (P<0.05), compared with the placebo group. Comparing different bowel habit subtypes, we observed that it was only in diarrhea predominant IBS (IBS-D) that vitamin D supplementation was able to significantly reduce the serum levels of TNF-α and IL-17 (P<0.05). However, in all subtypes, IL-10 and TAC increased, while MDA decreased (P<0.05) in vitamin D group, compared to the placebo group. Conclusion: Vitamin D3 supplementation reduces the serum IL-17 and MDA levels, and augments the serum IL-10 and TAC levels in IBS patients, particularly in IBS-D subtype. Thus, the present study demonstrates the beneficial effects of vitamin D on patients with IBS-D.