肠易激综合征患者临床特征和细胞因子的表达

发布时间：2018-02-09 09:46

  本文关键词： 肠易激综合征 焦虑 抑郁 细胞因子　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的:肠易激综合征(IBS)是一种常见的肠道功能性疾病,为全球多发病,虽然此病不威胁患者的生命,但由于病程长,易反复,不仅影响了患者的生活质量还增加了患者的经济负担。目前肠易激综合征的发病机制尚不明确,认为可能与精神心理因素、胃肠道的感染、脑-肠轴功能失调及肠道免疫功能异常等有关。已有研究表明肠道持续低度炎症是肠易激综合征的重要病理生理表现,但不同的研究尚存在争议,且IBS亚组中,感染后肠易激综合征(PI-IBS)和非感染后肠易激综合征(NPI-IBS)是否存在差异也尚不明确。因此,本研究根据有无胃肠道感染史将IBS患者分为PI-IBS和NPI-IBS组。通过评估PI-IBS和NPI-IBS患者胃肠道症状及焦虑和抑郁情况了解其临床特征,同时通过检测IBS患者及正常对照者外周血和肠黏膜中IL-17A,IFN-γ和IL-10的表达情况,探讨IBS患者促炎细胞因子和抗炎细胞因子的表达及IBS亚组之间是否存在差异,为以后IBS发病机制的研究提供依据。方法:按照罗马Ⅲ诊断标准纳入腹泻型IBS患者44例(PI-IBS 21例,NPI-IBS 23例),健康对照者10例,采用GSRS,SAS,SDS量表评估肠易激综合征患者胃肠道症状、焦虑及抑郁状态。肠镜下钳取回盲部及直肠黏膜标本,免疫组化法检测IL-17A,IFN-γ和IL-10的表达。采集两病例组及健康对照组肘静脉血,离心后取上层血清,ELISA法检测外周血IL-17A,IFN-γ和IL-10的表达。研究结果:1.PI-IBS组SAS评分较对照组和NPI-IBS组显著升高(P0.05),NPI-IBS组SAS评分稍高于对照组,但差异无统计学意义(P0.05);PI-IBS组SDS评分高于对照组和NPI-IBS组(P0.05),NPI-IBS组高于对照组(P0.05);PI-IBS组GSRS评分显著高于NPI-IBS组(P0.05)。2.与对照组相比,PI-IBS组和NPI-IBS组回盲部和直肠IL-17A,IFN-γ的表达升高,IL-10的表达降低(P0.05)。3.血清中PI-IBS组IL-17A的表达较对照组升高(P0.05);IFN-γ的表达在三组间差异无统计学意义(P0.05);PI-IBS组和NPI-IBS组IL-10的表达较对照组降低(P0.05);PI-IBS与NPI-IBS组之间的差异无统计学意义(P0.05)。4.肠黏膜和外周血中细胞因子的表达呈一致性变化,我们还发现PI-IBS组IL-17A和IFN-γ的表达较NPI-IBS组稍高,但差异无统计学意义(P0.05)。研究结论:1.PI-IBS和NPI-IBS患者存在不同程度的焦虑和抑郁表现。2.PI-IBS和NPI-IBS外周血和肠黏膜中IL-17A和IFN-γ的表达升高,IL-10表达降低。3.PI-IBS组和NPI-IBS组患者都存在肠道低度炎症,但PI-IBS患者临床症状较NPI-IBS患者重,细胞因子的改变更明显,PI-IBS可能与NPI-IBS有不同的发病机制。
[Abstract]:Background & objective: irritable bowel syndrome (IBS) is a common intestinal functional disease, which is a global disease. Although it does not threaten the life of patients, it is easy to repeat because of the long course of disease. It not only affects the quality of life of patients, but also increases the economic burden of patients. At present, the pathogenesis of irritable bowel syndrome is still unclear. Some studies have shown that persistent low-grade inflammation of the intestine is an important pathophysiological manifestation of irritable bowel syndrome, but different studies are still controversial, and in the IBS subgroup, It is not clear whether there are differences between PI-IBS and NPI-IBSs. In this study, patients with IBS were divided into PI-IBS and NPI-IBS groups according to their history of gastrointestinal infection. The clinical characteristics of patients with PI-IBS and NPI-IBS were evaluated by evaluating their gastrointestinal symptoms and anxiety and depression. At the same time, the expression of IL-17AtIFN- 纬 and IL-10 in peripheral blood and intestinal mucosa of IBS patients and normal controls were detected to investigate the expression of pro-inflammatory cytokines and anti-inflammatory cytokines and whether there were differences between IBS subgroups in IBS patients. Methods: according to the diagnostic criteria of Rome 鈪，

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