肠易激综合征内脏高敏感性研究现状和展望

肠易激综合征（irritable bowel syndrome,IBS）是一种以腹部不适和排便习惯改变为特征的胃肠功能性疾病。用于评估IBS患者内脏高敏感性的研究方法包括：内脏感知、反射反应和中枢反应，作为评估胃－肠通路上的内脏感觉传导异常的依据。目前证明内脏敏感性增高是其特征性的病理生理基础。IBS内脏高敏感性确切的神经生物学机制尚不清楚，可能包括肠道局部机械性受体和神经末稍的超敏感，神经通路及中枢神经短暂或长期的功能异常。其中异常的中枢兴奋性和神经－肥大细胞联系是IBS患者内脏高敏感的重要解发点。总之，脑－肠轴上有多种机制单独或共同作用形成内脏感觉的异常。上述部分发病机制已在动物高敏感模型中得到证实，而近年来神经生物学的研究进展提示在脑－肠轴的各个层面有不同的神经介质发挥作用，为IBS内脏高敏感性形成的机制提供了新思路。相信今后多角度、多层面的深入研究，最终有助于我们认识IBS内脏高敏感性确切的发生机制，用以指导临床治疗。

Progress in visceral hypersensitivity in irritable bowel syndrome

Irritable bowel syndrome(IBS) is a functional bowel disorder characterized by abdominal discomfort and altered bowel habits.Techniques applicable to evaluate the visceral hypersensitivity associated with brain gut dysfunction in IBS can be grouped under 3 headings: visceral perception,reflex responses and central responses.And visceral hypersensitivity has been proved to be a pathophysiological characteristic of patients with IBS.The exact mechanisms of visceral hypersensitivity in patients with IBS are unknown,perhaps involving supersensitive mechanoreceptor and primary afferents in the intestinal wall,transient or long term changes in peripheral and central pathways.Abnormal central excitability and nerve mast cell communication may be the trigger of visceral hypersensitivity in IBS.In summary,a variety of different mechanisms in brain gut axis,alone or in combination,may be responsible for visceral hypersensitivity.Some of these mechanisms have been characterized in animal models of hyperalgesia.Recent breakthroughs in the neurophysiology of visceral sensation provided clue on the development of visceral hypersensitivity about the candidate neurotransmitter, which involving brain gut interaction.Advanced investigation would give us more precise results in brain gut axis to explain the visceral hypersensitivity of IBS in future.