雌激素与大鼠内脏高敏感关系的实验研究

目的建立内脏高敏感的大鼠模型,比较血雌激素以及腹壁撤离反射(AWR)评分在各组大鼠间差异,探讨雌激素与大鼠内脏高敏感性的关系。方法成年雌性SD大鼠60只,随机分为卵巢切除组(OVX)、雌激素注射组(分5μg/kg、10μg/kg、20μg/kg、40μg/kg4个水平)、假手术组(Sham),术后各组均腹腔注射免疫诱导剂,在雌激素注射组中和第一次注射雌激素同时进行;以上处理2w后进行肛门直肠扩张(CRD),AWR评分评价内脏的敏感性。手术前后及AWR评分后放射免疫法各测定1次血雌激素。结果卵巢切除后各组大鼠血雌激素明显下降,Sham组无明显变化;各组AWR评分后血雌激素:20μg/kg和40μg/kg组均高于其余组,Sham组高于OVX、5μg/kg组;不同扩张体积间大鼠AWR评分均存在显著差异;1ml与2.0ml扩张时OVX与其余各组大鼠在各扩张水平下评分均存在明显差异;1.5ml扩张时5μg/kg组、10μg/kg组、20μg/kg组、Sham组均与40μg/kg组存在明显差异;AWR评分与雌激素剂量正相关。结论腹腔注射免疫诱导剂建造大鼠内脏高敏感性的模型适用于研究IBS与雌激素关系;雌激素与内脏高敏感性评分呈正相关,雌激素可能是大鼠内脏高敏感性形成的重要激素之一。     

肠易激综合征患者焦虑抑郁评价报告

肠易激综合征（IBS）是指一组包括腹痛、腹胀、排便习惯改变和排便形状异常的征候群，其症状持续存在或间歇发作，而又缺乏明确的形态学和生物学异常改变可以解释。作者通过汉密尔顿焦虑抑郁量表来测定不同病程的患者的焦虑抑郁程度，旨在探论肠易激综合征患者的焦虑抑郁状态及其焦虑程度与病程之间的关系。     

瞬时受体电位家族在肠易激综合征中的作用机制研究进展

瞬时受体电位(transient receptor potential, TRP)家族是一类位于细胞膜和胞内细胞器膜的阳离子配体门控通道蛋白。TRP通道广泛分布于哺乳动物的神经元和非神经细胞,在温度、pH值、机械力等多种物理因素和各种内、外源性的化学介质刺激下,参与躯体和内脏伤害性信号的感觉及传导,对肠易激综合征(irritable bowel syndrome, IBS)患者内脏高敏感性的产生有重要的作用。IBS患者结直肠中TRP通道的表达水平和功能发生明显改变,以TRP通道作为治疗IBS新的药物靶点在研究中取得了初步的成效,为治疗IBS提供了新的依据。     

肌电生物反馈对难治性肠易激综合症内脏痛觉敏感的影响

目的观察肌电生物反馈对难治性肠易激综合征(IBS)内脏痛觉敏感的影响,探讨心理因素与内脏敏感性的关系。 方法采用自身对照的方法,入组的60例IBS患者接受为期4周的肌电生物反馈治疗,治疗前、后分别测试患者的内脏痛觉阈值及焦虑、抑郁情绪。 结果4周后患者内脏痛觉阈值较治疗前明显升高（P<0.01）,汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）测试总分均明显下降（P<0.01）。内脏痛觉阈值变化指数与HAMA及HAMD测试总分变化指数均呈负相关(相关系数r分别为：r=-0.543,P<0.01;r=-0.728,P<0.01)。 结论焦虑、抑郁的不良情绪参与了IBS患者内脏高敏感性的形成,肌电生物反馈治疗可以降低IBS患者内脏高敏感性。     

肠易激综合征患者焦虑抑郁的调查分析及护理

目的：调查肠易激综合征患者的心理健康状况,针对问题,提出护理措施。方法：采用症状自评量表、焦虑自评量表、抑郁自评量表对36例肠易激综合征患者进行问卷调查,并将评分结果与全国常模进行比较,资料进行统计学分析。结果：肠易激综合征患者在症状自评量表中的总分、总均分、阳性项目数及多项因子分均高于全国常模（P〈0．05）;焦虑自评量表、抑郁自评量表评分均高于国内常模（P〈0．05）。结论：针对肠易激综合征患者出现的心理健康问题,提出以后在药物治疗的同时,要重视心理因素所起的作用,如注意加强疾病知识与饮食的指导,关心理解患者,提供心理社会支持,有针对性地进行心理治疗,以促进疾病的康复,提高患者生活质量。     

肠易激综合征发病机制的研究进展

肠易激综合征(Irritablebowelsyndrome,IBS)是腹部不适或腹痛伴排便异常的一组肠功能障碍综合征,无任何器质性或异常的生化指标。根据症状分为腹泻型、便秘型和腹泻便秘交替型。IBS是最常见的消化系疾病之一,西方国家有15%～20%的人患有IBS,我国潘国宗等近年用整群、随机抽样的方法进行的流行病学调查表明,有IBS症状者占北京地区人群的1%;广州魏秀清等用类似的方法调查表明有IBS症状者占该地区人群的5.6%。由于IBS的发病率呈逐年增多趋势,因而日益引起人们的重视。但IBS的病因和发病机制迄今还不完全清楚,其治疗也限于对症处理。若…     

肠易激综合征发病的内分泌机制

肠易激综合征 (ｉｒｒｉｔａｂｌｅｂｏｗｅｌｓｙｎｄｒｏｍｅ ,ＩＢＳ)是一种以肠平滑肌功能紊乱为主要表现的全身多因素疾病 ,发病率高 ,发病机制至今不清 ,诊断缺乏客观标志。作为一种调节肽 ,胃肠激素和其他内分泌因素在ＩＢＳ发病机制中的作用 ,逐渐受到关注。1　胃肠激素概念的演变自 190 2年 ,第一种人类胃肠激素促胰液素被发现以来 ,虽已近百年 ,但仅仅在近 10年余 ,由于细胞、分子生物学的发展 ,其研究才得以迅速开展 ,并逐步更新了传统的胃肠激素概念。1.1　胃肠激素概念的更新　胃肠激素的传统概念已不能概括胃肠道所产生的全部…     

肠易激综合征联合治疗对肠易激综合征病人心理精神因素的疗效评价

肠易激综合征(IBS)是消化系统常见的心身疾病,其患病率高,而有效维持治疗困难[1]。IBS的病因和发病机制迄今还不完全清楚,其治疗多局限于对症治疗。国外报道联用抗抑郁药能取得较好疗效[2],本研究对IBS患者心理精神因素状况作一些研究,在常规综合治疗的基础上联用抗抑郁/焦虑药     

肠易激综合征发病机制的研究进展

<正>肠易激综合征(IBS)是临床常见的慢性胃肠功能紊乱性疾病,以不定部位的腹痛、腹胀,或伴排便习惯和大便性状异常为特征。该病症状处于持续或间歇发作状态,且经相关检查无器质性病变。研究表明[1-2],1997年北京地区IBS流行率在7%左右,而在西方国家,成年人中IBS发病率约为8%~23%。该病病程较长,且反复发作,大     

肠易激综合征的护理

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肠病,须经检查排除可引起这些症状的器质性疾病。常与其他功能性肠病的症状重叠。其诊断主要依据症状,参照罗马标准Ⅲ：最近3个月内,每个月至少有3d出现反复发作的腹痛或不适症状,并具有下列中的2项及以上：①排便习惯的改变;②伴随排便频率的改变;③伴随粪便性状的改变。     

Intestinal membrane permeability and hypersensitivity in the irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in which the underlying pathophysiology is poorly understood; however, increased intestinal permeability in diarrhea-predominant IBS patients has been reported. Here we demonstrate that diarrhea-predominant IBS (D-IBS) patients display increased intestinal permeability. We have also found that increased intestinal membrane permeability is associated with visceral and thermal hypersensitivity in this subset of D-IBS patients. We evaluated 54 D-IBS patients and 22 controls for intestinal membrane permeability using the lactulose/mannitol method. All subjects ingested 5 g of lactulose and 2 g of mannitol in 100 ml of water after which their urine was collected. We also evaluated the mean mechanical visual analogue scale (M-VAS) pain rating to nociceptive thermal and visceral stimulation in all subjects. All study participants also completed the FBDSI scale. Approximately 39% of diarrhea-predominant IBS patients had increased intestinal membrane permeability as measured by the lactulose/mannitol ratio. These IBS patients also demonstrated higher M-VAS pain intensity reading scale. Interestingly, the IBS patients with hypersensitivity and increased intestinal permeability had a higher FBDSI score (100.8 ± 5.4) than IBS patients with normal membrane permeability and sensitivity (51.6 ± 12.7) and controls (6.1 ± 5.6) (p < 0.001). A subset of D-IBS patients had increased intestinal membrane permeability that was associated with an increased FBDSI score and increased hypersensitivity to visceral and thermal nociceptive pain stimuli. Thus, increased intestinal membrane permeability in D-IBS patients may lead to more severe IBS symptoms and hypersensitivity to somatic and visceral stimuli.     

Widespread hypersensitivity is related to altered pain inhibition processes in irritable bowel syndrome

The mechanisms of chronic pain in irritable bowel syndrome (IBS) have been widely investigated but remain unclear. The present study investigated the relation between visceral hypersensitivity, cutaneous thermal sensitivity, and central pain mechanisms. Rectal sensitivity was assessed with a barostat, and forearm and calf sensitivity with a contact thermode. Central mechanisms were assessed by counterirritation using sustained cold-pain to the hand and painful electric shocks to the ankle. Psychological symptoms were also assessed, using questionnaires. Female volunteers with diarrhea-predominant IBS (n = 27) and healthy controls (n = 25) participated in the study. IBS patients had lower rectal and calf pain thresholds compared to controls (p’s < 0.05). IBS patients also reported more pain than controls for rectal distensions, and heat pain on the calf and forearm (all p’s < 0.001). Cold-pain inhibited shock-pain in controls but not IBS patients (controls: −13.5 ± 5.3 vs IBS: +1.9 ± 10.5; p < 0.01). In addition, visceral hypersensitivity was significantly correlated to cutaneous thermal hypersensitivity and pain inhibition deficits, although effects were only weak and moderate, respectively. Furthermore, covariance analyses indicated that psychological factors accounted for group differences in visceral hypersensitivity and pain inhibition deficits. In conclusion, this study confirms the relation between altered pain inhibition processes and widespread hypersensitivity in IBS. The present results also suggests that psychological symptoms and altered pain processing in IBS patients may reflect at least in part, common underlying mechanisms.     

直肠刺激的脑功能磁共振成像研究

目的：运用功能磁共振成像(fMRI)研究正常人和肠易激综合征(IBS)患者直肠刺激时脑内局部活动。方法：11名正常人和26例IBS患者为对象。以不同气体容量扩张直肠获得fMRI图像，并和T1W解剖图像融合，进行脑内活动区的面积和信号强度分析。结果：大多数正常人和IBS患者的直肠刺激明显激活扣带回前皮层(ACC)、脑岛皮层(IC)、前额叶皮层(PFC)和丘脑(THAL)。在正常人中，注气量达90ml和120ml时，均以ACC中的活动Ⅸ面积最大；在不同的注气量时，绝大多是以PFC和ACC中的活动区MR信号强度变化幅度最大。在相同容积直肠刺激时，IBS患者脑内活动区比正常人组活跃；IBS患者组在疼痛性直肠扩张时脑内活动区以PFC最为明显。结论：正常人直肠刺激时，中枢兴奋区主要位于ACC和PFC；而IBS患者在疼痛性直肠扩张时以PFC为主。     

Enhanced affect/cognition-related brain responses during visceral placebo analgesia in irritable bowel syndrome patients

Placebo analgesia is a psychosocial context effect that is rarely studied in visceral pain. Patients with irritable bowel syndrome (IBS) exhibit visceral hyperalgesia and heightened affective/cognitive brain region activation during visceral stimuli. Psychological factors alter the pain and brain activation pattern, and these changes are more pronounced in IBS patients. Expectation constitutes the major neuropsychological mechanism in the placebo effect. This study confirmed the heightened affective/cognitive brain responses in IBS patients during visceral placebo analgesia using a placebo model with expectation, which was enhanced by suggestion and conditioning. Seventeen IBS patients and 17 age-/sex-matched controls were enrolled. Psychophysical inventories (Hospital Anxiety and Depression Scale [HADS], visual analogue scale, and short-form McGill questionnaire) were completed. Brain activity during placebo intervention and anticipation was assessed in response to rectal distension using 3T-functional magnetic resonance imaging. Suggestion-/conditioning-enhanced placebo was used to convince controls/patients of the efficacy of a newly developed intravenous drug (saline, in actuality) for the relief of rectal distension-induced visceral pain. A comparable visceral placebo analgesia was observed in IBS patients and control subjects. IBS patients demonstrated a higher HADS-anxiety score, which was predictive of a weak placebo effect. Suggestion-/conditioning-enhanced placebo evoked more activity in affective/cognitive brain regions (insula, midcingulate cortex, and ventrolateral prefrontal cortex [VLPFC]) in IBS patients than in healthy controls. VLPFC was also more active during anticipation in IBS patients. In conclusion, IBS patients and control subjects achieved comparable placebo analgesia during experimentally induced rectal pain. The visceral placebo analgesia produced heightened activity in affective/cognitive brain regions in IBS patients.     

Central and peripheral hypersensitivity in the irritable bowel syndrome

Previous investigations of somatic hypersensitivity in IBS patients have typically involved only a single stimulus modality, and little information exists regarding whether patterns of somatic pain perception vary across stimulus modalities within a group of patients with IBS. Therefore, the current study was designed to characterize differences in perceptual responses to a battery of noxious somatic stimuli in IBS patients compared to controls. A total of 78 diarrhea-predominant and 57 controls participated in the study. We evaluated pain threshold and tolerance and sensory and affective ratings of contact thermal, mechanical pressure, ischemic stimuli, and cold pressor stimuli. In addition to assessing perceptual responses, we also evaluated differences in neuroendocrine and cardiovascular responses to these experimental somatic pain stimuli. A subset of IBS patients demonstrated the presence of somatic hypersensitivity to thermal, ischemic, and cold pressor nociceptive stimuli. The somatic hypersensitivity in IBS patients was somatotopically organized in that the lower extremities that share viscerosomatic convergence with the colon demonstrate the greatest hypersensitivity. There were also changes in ACTH, cortisol, and systolic blood pressure in response to the ischemic pain testing in IBS patients when compared to controls. The results of this study suggest that a more widespread alteration in central pain processing in a subset of IBS patients may be present as they display hypersensitivity to heat, ischemic, and cold pressor stimuli.     

帕罗西汀治疗肠易激综合征抑郁症的疗效评价

目的评价帕罗西汀对肠易激综合征(Irritable bowel syndrome,IBS)的症状疗效及抑郁量表评分影响。方法选择2003年1月至2004年6月在全科门诊诊断的伴有抑郁症状的IBS患者60例,随机分成两组,治疗组32例,抑郁评分为58.50±4.24,采用对症治疗,同时,用帕罗西汀治疗,帕罗西汀20mg每日一次,共8w,疗程结束后随访4~6个月;对照组28例,抑郁评分56.48±4.35,只采用对症治疗。观察两组的临床疗效和抑郁评分的影响。结果治疗组的疗效评价32例中有效28例,有效率为87.50%。对照组有效17例,有效率为60.72%。两组患者疗效间比较,差别有显著性意义(P<0.05)。治疗组抑郁评分下降明显,与对照组比较,差异有显著性意义。结论帕罗西汀治疗伴有抑郁症状的IBS疗效显著。     

Testing the sequential model of pain processing in irritable bowel syndrome: a structural equation modeling analysis.

Pain, the cardinal feature of irritable bowel syndrome (IBS), is a multidimensional phenomenon with sensory and affective dimensions. Price's pain processing model was used to delineate four a priori sequentially related stages (pain sensation intensity, immediate pain unpleasantness, long-term suffering, and pain-related behavior). Although prior research with both healthy individuals and somatic pain patients supports the model in general, its applicability to IBS is unclear. Our goal was to extend the scope of the sequential model and test its fundamental tenets using structural equation modeling (SEM) with data obtained from 168 Rome II diagnosed IBS patients (19% male, 81% female). A secondary goal was to assess the relationship between a set of contextual factors associated with IBS (age, gender, trait anxiety) and the four pain stages. Results were consistent with a successive order of pain processing such that the pain sensation directly impacts pain unpleasantness, which, in turn, leads to suffering and illness behaviors. However, contrary to a model with strictly successive stages, pain sensation had independent effects on illness behaviors over and above pain affect. The effect of anxiety on illness behavior was mediated by suffering, while psychopathology directly influenced pain sensation and pain unpleasantness but not later stages. Age was related to pain sensation and illness behaviors but not pain affect. Gender tended to be more strongly associated with more distal pain stages (e.g., pain affect) vis-a-vis its effects on pain sensation. These data are generally supportive of a four-stage pain processing model.     

肠易激综合症患者的心理健康状况及应付方式调查

目的探讨肠易激综合症(Irritable Bowel Syndrom,IBS)患者的心理健康状况、应付方式及相关因素.方法对68例腹泻型IBS患者进行症状自评量表(SCL-90)、EPQ(龚耀先修订艾森克成人个性问卷)测查、应付方式问卷和一般情况调查分析.结果 68例IBS患者的SCL-90总均分与中国常模均分比较有显著统计学意义,总均分≥2.0分占77.95%,总均分≥3分占57.4%,总均分异常人数(≥1.8分)占97.1%.EPQ测试结果示男性IBS患者不稳定内倾型、女性IBS患者不稳定型外倾型的人数较多.应付方式以消极应付为主.多因素分析结果表明,与IBS明显相关的因素是性别(女性)、收入(中等收入)、一年内是否有精神应激事件、自感精神紧张等.结论 IBS患者的心理健康状况已经达到了十分严重的程度.其发生发展与社会心理因素、应付方式和个性密切相关.IBS的治疗要兼顾病人的生物和心理社会两个方面,加强心理治疗和精神药物治疗,提高包括IBS在内的心身疾病的治疗效果.     

肠易激综合征患者血清中过氧化还原酶1和脑源性神经营养因子与抑郁和焦虑症状的相关性研究

目的 探讨肠易激综合征(IBS)患者血清中过氧化还原酶1和脑源性神经营养因子与抑郁和焦虑症状的相关性研究.方法 回顾性选择2020年2月至2021年3月上海中医药大学附属曙光医院消化科门诊收治的150例慢性腹泻患者.参考罗马Ⅳ标准将患者分为IBS 80例(IBS组),非IBS 70例(非IBS组);检测并比较两组患者的...