肠道感染与肠易激综合征

目的 探讨肠道急性感染与肠易激综合征（IBS）的关系。方法 对患病前无肠功能紊乱的295例痢疾／肠炎患者（235例为细菌性痢疾）及243例未曾患过痢疾／肠炎的配偶或兄弟姐妹（对照组）进行随访。检测了30例IBS患者及12例对照组末端回肠、直肠与乙状结肠交界处肠黏膜内白细胞介素（IL）－1α、IL－1β、IL－1ra的mRNA表达。结果 患过痢疾／肠炎者1－2年内66例（22．4％）有持续的肠功能紊乱,24例（占痢疾病人的10．2％）发展为IBS。对照组肠功能紊乱的患病率为7．4％,IBS的患病率为0．8％。其中痢疾／肠炎长者,发生肠功能紊乱的危险度高,8－＞15d的OR＝3．5－4．6。有痢疾／肠炎史的IBS患者末端回肠、直肠与乙状结肠交界处肠黏膜IL－1β mRNA的表达增高。结论 肠道感染可能通过免疫因素参与IBS的发病。

Intestinal infection and irritable bowel syndrome

OBJECTIVE: To determine whether intestinal infection plays a role on the pathogenesis of irritable bowel syndrome (IBS). METHODS: 295 patients who had no previous history of functional bowel disorder had received treatment for dysentery (n = 235) or for acute bowel infection at the hospital between April-October, 1998, were followed up for 1 - 2 years and evaluated for their subsequent bowel habits. A cohort study of 243 subjects using their siblings, husbands or wives who did not have dysentery or acute bowel infection at the same period was taken as control. Furthermore, the contents of mRNAs of IL-1alpha, IL-1beta and IL-1ra in the mucosa at the terminal ileum and recto-sigmoid junctions were determined and compared using RT-PCR method in 30 IBS patients and 12 controls. RESULTS: (1) Sixty-six (22.4%) patients were reported to have functional bowel disturbance, and 24 (8.1% total and 10.2% among cases of dysentery) developed IBS in the study group, whereas, only 7.4% had altered bowel habit and 0.8% had IBS in the control group (P < 0.01). (2) The risk of having functional bowel disturbance was higher in patients who suffered from a longer duration (> 8 d, OR = 3.5) of dysentery. (3) The IL-1beta mRNA level in the mucosa of terminal ileum and recto-sigmoid junction of IBS patients with dysentery was higher than that of controls and IBS patients without dysentery (P < 0.01). CONCLUSION: Intestinal infection plays a role on the pathogenesis of IBS through some immunological factors.