小肠细菌过度生长在肠易激综合征中的研究进展

肠易激综合征(IBS)是一种常见的功能性胃肠病,其发病机制复杂。目前认为IBS与胃肠动力障碍、内脏高敏感、肠道感染、脑-肠轴功能紊乱、免疫活化等因素有关。最新研究表明小肠细菌过度生长(SIBO)在IBS的发病中亦起重要作用。本文就SIBO在IBS中的研究进展,包括病理生理机制、诊断、治疗等作一综述。     

Changes in Fecal Calprotectin After Rifaximin Treatment in Patients With Nonconstipated Irritable Bowel Syndrome

Background

Fecal calprotectin, an indicator of colonic inflammation, is associated with nonconstipated irritable bowel syndrome. Rifaximin is an antibiotic used to treat nonconstipated irritable bowel syndrome. We performed a retrospective review of patient charts to investigate the changes in fecal calprotectin levels and intestinal symptoms following treatment with rifaximin in patients with nonconstipated irritable bowel syndrome with elevated fecal calprotectin.

肠易激综合征患者服用酪酸菌制剂前后的肠道菌群变化

目的:肠易激综合征(IBS)常合并存在肠道菌群失调,缺乏特效疗法。酪酸菌(Cb)是一种含有耐酸性芽胞的微生态制剂,本研究用于治疗IBS,观察酪酸菌制剂的临床疗效及肠道菌群状况。方法:从门诊随机选择21例男性,9例女性。检测大便常见菌群和病原菌,采用Miles-Misro介绍的滴注法操作。每次培养时均选上述细菌标准菌株一同培养作质控。结果:治疗前总厌氧菌、双歧杆菌和乳酸杆菌下降,而有潜在致病性的梭菌明显上升,无致病菌生长。治疗后腹泻次数明显减少,总有效率为83.4％,双歧杆菌和乳酸杆菌升高明显。结论:IBS易致肠菌失调。酪酸菌能抑制肠道内腐败菌、病原菌,并能促进双歧杆菌,乳酸菌等肠道内的有益菌发育。     

肠易激综合征患者直肠肛门动力学研究

为了研究肠易激综合征患者肛门运动功能，我们测定了５０例ＩＢＳ患者在１１例正常人直肠肛门压力衣排便功能；发现：（１）直肠静息压，肛门括约肌静息压及其最大缩窄压在ＩＢＳ腹泻组，便秘组及正常对照组组均无显著差异。（２）肛管高压带长度在ＩＢＳ腹泻组及便秘组均显著高于正常对照组。（３）直肠壶腹部的感觉阈值，最大耐受量等，在ＩＢＳ腹泻组均显著低于正常对照组。（４）ＩＢＳ便秘组感觉阈值与正常对照组差异，但其最大     

腹泻型肠易激综合征患者肠黏膜肥大细胞的变化

目的探讨腹泻型肠易激综合征(IBS)与肠黏膜肥大细胞(MC)及脱颗粒之间的关系。方法正常人10例和腹泻型IBS患者11例。每例于结肠镜下取盲肠、横结肠和直肠黏膜组织各2块,用免疫组化方法行MC染色,计算每高倍视野下MC的数量及脱颗粒MC所占MC总数的比例。结果腹泻组IBS患者盲肠、横结肠黏膜MC数量显著高于正常对照组(P<0·01及P<0·05);直肠黏膜MC数量与正常对照组无显著差异(P>0·05)。腹泻型IBS患者盲肠、横结肠、直肠黏膜脱颗粒MC比率显著高于正常对照组(P<0·05或P<0·01)。结论肠黏膜肥大细胞在腹泻型IBS的发病过程中起着重要作用。     

肠易激综合征血浆及乙状结肠粘膜中生长抑素的变化

应用放射免疫分析法检测正常组２４例及肠易激综合征组２６例受检者血浆及乙状结肠粘膜中生长抑素的含量，旨在探讨ＩＢＳ患者历浆及乙状结肠粘膜中ＳＳ的含量有无变化，以及它在ＩＢＳ疾病过程中的可能作用和临床意义。结果；ＩＢＳ组血浆中ＳＳ的浓度明显高于正常组；乙状结肠粘膜中的ＳＳ的含量痛秘型ＩＢＳ显著高于痛泻型，痛泻型ＩＢＳ显著高于正常组。     

肠易激综合征患者心血管自主神经功能变化与心率变异性的关系

目的 :探讨肠易激综合征 (1BS)患者心血管自主神经功能变化与心率变异性 (HRV)的关系。方法 :对IBS患者 50例进行标准心血管自主神经功能测试 ,将其结果分成阳性组 (DNA+ )及阴性组 (DNA- ) ,健康人 30名为对照组。 2 4h动态心电图进行HRV分析。结果 :IBS患者自主神经功能异常的发生率为 58% ,主要表现为迷走神经功能异常 ;HRV时域分析中DNA+ 组SDNN、SDANN、SDNNindex明显减少 ;DNA+ 及DNA- 组中反映副交感神经张力的RMSSD、PNN50 、HF等指标明显增高 ,LF/HF比值明显减低 ,与对照组比较有显著性差异 (P <0 .0 5)。结论 :IBS患者存在副交感神经张力增加。HRV分析是发现IBS患者自主神经功能异常的较好方法     

肠易激综合征患者的胃排空

应用锝＾９０标记的固体试餐对３０例健康者及５６例肠是铁激综合征患者的胃排空功能进行了观察。５６例肠易激合征患乾按临床症状分为２组，第１组为腹泻为主者，共２０例，第２组３６例系以腹痛及便秘为主要表现者。     

Relationships Between Malnutrition,Inflammation, Sleep Quality,and Restless Legs Syndrome in Hemodialysis Patients

Restless legs syndrome (RLS) is a common neurologic sensorimotor disorder. It is also seen in hemodialysis patients in whom the mechanism is not thoroughly understood. The aim of this study was to evaluate the association between malnutrition‐inflammation score (MIS), sleep quality, and RLS in chronic hemodialysis patients. This cross‐sectional study included 232 adult stable chronic hemodialysis patients (mean age 60.9 ± 14.1 years, 56.5% male). RLS frequency, MIS, Pittsburgh Sleep Quality Index (PSQI), laboratory data of patients as well as severity of RLS were evaluated. Thirty‐seven patients (15.9%) were diagnosed with RLS. Mean MIS of patients with or without RLS were similar. PSQI of patients with RLS was significantly higher than patients without RLS (P = 0.002). There was a significant positive correlation between RLS severity and PSQI (r = 0.445, P = 0.006). A significant positive correlation was also found between PSQI and MIS in patients with RLS (r = 0.419, P = 0.010). RLS severity was positively correlated with some inflammatory parameters such as white blood cell count and C‐reactive protein (r = 0.427, P = 0.008 and r = 0.418 P = 0.010). PSQI was found as an independent significant predictor of RLS (odds ratio [OR] = 1.15 (1.06–1.25), P = 0.001) in multivariate logistic regression analysis. Our study revealed that there was no significant relationship between RLS and MIS in chronic hemodialysis patients. However, RLS severity is correlated with inflammatory parameters. Also, sleep quality in chronic hemodialysis patients with RLS is negatively associated with MIS.     

肠易激综合征血浆及乙状结肠粘膜中VIP及SS的含量

目的 :探讨肠易激综合征 (IBS)患者血浆及乙状结肠粘膜中血管活性肠肽 (VIP)、生长抑素 (SS)有无变化 ,以及它们在IBS发病过程中的可能作用和临床意义。方法 :应用放射免疫分析法 (RIA)测定IBS患者血浆及乙状结肠粘膜内VIP、SS的含量 ,并与正常组比较。结果 :便秘型IBS血浆及乙状结肠粘膜中VIP含量显著高于正常组 (P <0 .0 1 ) ,腹泻型显著低于正常组 (P <0 .0 5) ;SS在IBS各组均显著高于正常组 (P <0 .0 5) ,而便秘型又显著高于腹泻型 (P <0 .0 5)。结论 :IBS患者存在VIP、SS含量异常 ,且这些异常可能在IBS发病中起一定的作用 ;不同类型IBS患者VIP及SS含量有显著差异 ,说明不同类型IBS在发病机制上有其不同的病理生理学基础     

Small Intestinal Bacterial Overgrowth and Lactose Intolerance Contribute to Irritable Bowel Syndrome Symptomatology in Pakistan

Background /Aim:

The symptoms of irritable bowel syndrome resemble those of small intestinal bacterial overgrowth (SIBO). The aim of this study was to determine the frequency of SIBO and lactose intolerance (LI) occurrence in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) according to Rome III criteria.

Patients and Methods:

In this retrospective case-control study, patients over 18 years of age with altered bowel habit, bloating, and patients who had lactose Hydrogen breath test (H₂BT) done were included. The “cases” were defined as patients who fulfill Rome III criteria for IBS-D, while “controls” were those having chronic nonspecific diarrhea (CNSD) who did not fulfill Rome III criteria for IBS-D. Demographic data, predominant bowel habit pattern, concurrent use of medications, etc., were noted.

Results:

Patients with IBS-D were 119 (51%) with a mean age of 35 ± 13 years, while those with CNSD were 115 (49%) with mean age 36 ± 15 years. Patients in both IBS-D and CNSD were comparable in gender, with male 87 (74%) and female 77 (64%). SIBO was documented by lactose H₂BT in 32/234 (14%) cases. It was positive in 22/119 (19%) cases with IBS-D, while 10/115 (9%) cases had CNSD (P = 0.03). LI was positive in 43/234 (18%) cases. Of these, 25/119 (21%) cases had IBS-D and 18/115 (16%) cases had CNSD (P = 0.29).

Conclusion:

SIBO was seen in a significant number of our patients with IBS-D. There was no significant age or gender difference in patients with or without SIBO.     

Small Intestinal Bacterial Overgrowth in Patients with Interstitial Cystitis and Gastrointestinal Symptoms

Purpose Interstitial cystitis (IC) often coexists with irritable bowel syndrome (IBS). IBS may be explained by small-intestinal bacterial overgrowth (SIBO), which increases immune activation and visceral hypersensitivity. This prospective pilot study tested hypotheses that IC patients with gastrointestinal (GI) symptoms have SIBO, that nonabsorbable antibiotic use improves symptoms, and that improvement is sustained by prokinetic therapy. Methods Consecutive IC patients with GI symptoms had lactulose breath testing (LBT). Those with abnormal results received rifaximin 1,200–1,800 mg/day for 10 days then tegaserod 3 mg/nightly. Questionnaires addressed IC and GI global improvement. Results Of 21 patients, 17 (81%) had abnormal LBTs. Of 15 patients treated, GI global improvement was moderate to great in 11 (73%) and sustained in ten (67%). IC global improvement was moderate to great in six (40%) and sustained in seven (47%). Conclusions A majority of IC patients and GI symptoms had an abnormal LBT suggesting SIBO. Rifaximin improved symptoms, which was sustained by tegaserod.     

细胞因子与IBS病人心理状况关系的初探

目的探讨肠易激综合征(IBS)患者的心理状况及细胞因子和皮质醇相关性因素。方法对46例IBS患者进行焦虑自我评定量表(SAS)和抑郁自我评定量表(SDS)问卷调查;应用放免法测定血清白介素-1β(IL-1β)、白介素-10(IL-10)和皮质醇浓度。结果IBS患者的血清IL-1β、IL-10和皮质醇水平均显著高于对照组(均P<0·01);SAS和SDS评分与中国常模[1]比,IBS患者SAS和SDS评分均显著高于中国常模(均P<0·05);SDS积分与IL-10和皮质醇呈直线正相关(r=0·65,P<0·01和r=0·59,P<0·01),与IL-1β不存在相关性。结论IBS患者存在炎症反应及炎症调节不平衡;存在抑郁和焦虑状态,抑郁可能与炎症因子失衡有关。     

得舒特治疗肠易激综合征的临床疗效观察

目的:评价得舒特对肠易激综合征(IBS)的疗效。方法:56例根据罗马标准诊断为IBS的患者进入本研究。所有患者在服用得舒特治疗前一周服用安慰剂6天。安慰剂治疗无效的47例患者随后进入得舒特治疗,50mg,每日3次口服,疗程4周。结果:得舒特对肠易激综合征患者腹痛、腹泻和便秘单项症状的有效率分别为85.1％(40/47)、89.2％(33/37)和93.3％(14/15),对肠易激综合征的总有效率为85.1％(40/47)。治疗期间除2例诉头晕外,无其他不良反应。结论:得舒特治疗1BS疗效确切、副反应率低,临床上可作为治疗IBS的首选药物之一。