肠易激惹综合征结肠粘膜TH17细胞的免疫激活及相关因素的研究

发布时间：2018-03-14 09:41

本文选题：腹泻型肠易激惹综合症　切入点：TH17细胞　出处：《泰山医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的肠易激惹综合症是临床常见胃肠功能紊乱性疾病，发病机制复杂，涉及感染、应激、过敏、自主神经功能紊乱、内分泌等多方面原因，尚无完美机制阐释发病机制。在炎症性疾病关节破坏性疾病中发现T细胞亚群，命名TH17细胞，分化来源于CD4+T细胞，TH17细胞通过分泌IL-17参与多种疾病的发生发展机制，探讨TH17细胞激活与肠易激惹综合征的发病关系。探讨TH17细胞在肠易激惹综合征中激活影响因素与食物过敏、应激的联系。方法根据罗马III诊断标准选取IBS-D病例组30人，取正常志愿者20人作为对照组。对研究对象检测血清标本中IL-17含量；对所有研究对象进行心理测试，行焦虑和焦虑量表评分，评估焦虑与抑郁状态的症状积分严重程度；对研究对象抽血行血清14种食物过敏原检测，检测过敏原；并分别电子结肠镜检查，分别在回盲部、横结肠、乙状结肠取组织病理进行IL-17免疫组织化学染色，免疫组化后医学图像处理对比病例组与对照组中组织的表达评定免疫组化积分。分析焦虑、抑郁，过敏原，对肠粘膜TH17细胞及外周血IL-17的影响。结果 1、病例组与对照组，结肠粘膜TH17细胞免疫组化积分，病例组：8±4.26，对照组4.9±3.77，两组比较，有统计学差异（P0.05）。 2、病例组与对照组，血清IL-17水平，病例组：24.71±20.62，对照组19.66±15.99，两组比较无统计学差异（P0.05）。 3、病例组与对照组心理应激：焦虑评分，7.13±4.48，1.70±1.56，两组比较有统计学意义（P0.01）；抑郁评分，6.97±3.31，2.10±1.83，两组比较有统计学差异（P0.01）。 4、病例组与对照组食物过敏原检测结果：病例组：青霉素（病例组25/30，对照组11/20，P0.05）；牛奶（病例组26/30，对照组7/20，P0.01）；羊肉（病例组23/30，对照组9/20，P0.05），有统计学差异。两组比较过敏原积分，，病例组：20.67±7.96，对照组：3.65±3.65，有统计学差异（P0.01），过敏原种类，病例组：12.3±4.66，对照组：10.85±2.28，没有显著统计学差异（P0.05）。 5、病例组与对照组，免疫组化积分与过敏原积分及过敏原种类相关分析结果分别为：相关系数r=0.579；r=0.477，均有统计学相关关系（P0.05），与焦虑：r值0.123；抑郁：r=0.354；血清IL-17：r=0.159，都没有相关关系（P0.05）。结论 1、IBS-D结肠粘膜存在TH17细胞的免疫激活，TH17细胞可能参与IBS-D的发病机制。 2、IBS-D结肠粘膜TH17细胞的激活与食物过敏严重程度相关，食物过敏可能是IBS-D诱发因素。 3、IBS-D存在心理应激水平差异，焦虑及抑郁可能参与IBS的发病，但心理应激的可能与TH17细胞活化无关。
[Abstract]:Purpose. Irritable bowel syndrome is a common clinical gastrointestinal dysfunction disease, the pathogenesis of complex, involved in infection, stress, allergies, autonomic nervous dysfunction, endocrine and other reasons, There is no perfect mechanism to explain the pathogenesis. T-cell subsets were found in inflammatory diseases and joint destructive diseases, named TH17 cells. The differentiation of TH17 cells derived from CD4 T cells involved in the pathogenesis of many diseases by secreting IL-17. To investigate the relationship between the activation of TH17 cells and the pathogenesis of irritable bowel syndrome and the relationship between the activation of TH17 cells in irritable bowel syndrome and food allergy and stress. Method. According to Roman III diagnostic criteria, 30 IBS-D patients and 20 normal volunteers were selected as control group. The contents of IL-17 in serum samples were measured, and psychological tests were performed on all subjects, and anxiety and anxiety scale scores were scored. To assess the severity of symptoms of anxiety and depression, to detect 14 kinds of food allergens in serum, and to detect allergens in the ileocecum and transverse colon, respectively. The histopathology of sigmoid colon was stained with IL-17 immunohistochemical staining, and the expression of tissue in the case group was compared with that in the control group. Effect on TH17 cells of intestinal mucosa and IL-17 in peripheral blood. Results. 1. The immunohistochemical score of TH17 cells in the colonic mucosa of the case group and the control group was 8 卤4.26 and 4.9 卤3.77, respectively. There was significant difference between the two groups (P 0.05). 2. The serum IL-17 level in the case group and the control group was 24.71 卤20.62 and 19.66 卤15.99 respectively. There was no significant difference between the two groups (P 0.05). 3. Psychological stress in the case group and the control group: anxiety score was 7.13 卤4.48 卤1.70 卤1.56, there was significant difference between the two groups (P 0.01), depression score was 6.97 卤3.31 卤2.10 卤1.83, there was significant difference between the two groups (P 0.01). 4. Results of food allergen detection in case group and control group: case group: penicillin group (case group 25 / 30, control group 11 / 20 P 0.05), milk (case group 26 / 30, control group 7 / 20 P 0.01), lamb (case group 23 / 30, control group 9 / 20 P 0.05), there was statistical difference. There was no significant difference (P 0.05) between the case group and the control group (w: 20.67 卤7.96, control group: 3.65 卤3.65, P 0.01), allergen type: 12.3 卤4.66 in the case group, and 10. 85 卤2. 28 in the control group. 5. In the case group and the control group, the correlation analysis results between immunohistochemical score and allergen score and allergen type were as follows: correlation coefficient r = 0.579 / r = 0.477. there was a statistical correlation between the correlation coefficient (P < 0.05), and anxiety: r = 0.123; depression: r = 0.354; serum IL-17: r = 0.159, no correlation was found between the two groups. Conclusion. 1in the colon mucosa of IBS-D, the immune-activated TH17 cells and TH17 cells may be involved in the pathogenesis of IBS-D. 2Activation of TH17 cells in IBS-D colon mucosa was related to the severity of food allergy, and food allergy might be a factor of IBS-D. 3There were differences in the level of psychological stress in IBS-D. Anxiety and depression may be involved in the pathogenesis of IBS, but the psychological stress may not be related to the activation of TH17 cells.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.4

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