腹泻型肠易激综合征患者内脏敏感性、肠屏障功能及自主神经功能的评价

发布时间：2018-06-19 03:07

本文选题：腹泻型肠易激综合征 + 内脏敏感性　；参考：《中南大学学报(医学版)》2017年05期

【摘要】：目的:评价腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,IBS-D)患者的内脏敏感性、肠屏障功能和自主神经功能(autonomic nerve function,ANF),探索它们在IBS-D病理生理学中的作用。方法:以2015年10月至2016年3月就诊于中日友好医院消化内科的46例IBS-D患者(IBS-D组)和20例健康志愿者(对照组)为研究对象,采用问卷评估其临床及精神心理症状,并检测内脏敏感性、肠屏障功能及ANF,比较两组上述各指标的差异,并分析IBS-D组中各指标间的相关性。结果:IBS-D组的病情尺度调查表(IBS symptom severity scale,IBS-SSS)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和内脏敏感指数(visceral sensitivity index,VSI)评分均显著高于对照组(P0.01)。内脏敏感性检测中,IBS-D组对直肠扩张刺激的最大耐受阈值显著低于对照组(P0.01),初始感觉阈值和持续排便阈值两组差异无统计学意义(P0.05)。肠屏障功能血清标志物二胺氧化酶(diamine oxidase,DAO)和D-乳酸在IBS-D组中均显著升高(均P0.05)。IBS-D组的ANF总分和副交感计分以及两者的异常比例均显著高于对照组(均P0.05)。在IBS-D组各指标相关性分析中,HAMA,VSI和血清DAO与IBSSSS呈显著正相关(分别r=0.528,0.575,0.507;P0.01),3个内脏感觉阈值均与IBS-SSS呈显著负相关(分别r= 0.636, 0.476, 0.697,P0.01);与内脏感觉阈值呈显著负相关的指标除IBS-SSS外,还有HAMA,HAMD,VSI和血清DAO(均P0.05);ANF与其他指标间未发现关联。结论:IBS-D患者存在精神心理异常、内脏高敏感、肠屏障受损和以副交感神经功能异常为主的ANF失调,前三者均与病情程度相关,可能在IBS-D病理生理学中发挥了重要作用。
[Abstract]:Objective: to evaluate the visceral sensitivity, intestinal barrier function and autonomic nerve function of diarrhea irritable bowel syndrome (IBS-D), and to explore their role in the pathophysiology of IBS-D. Methods: from October 2015 to March 2016, 46 IBS-D patients (IBS-D group) and 20 healthy volunteers (control group) who were admitted to the Department of Digestive Medicine of Sino-Japanese Friendship Hospital were used to evaluate their clinical and psychological symptoms. The visceral sensitivity, intestinal barrier function and ANF. were compared between the two groups, and the correlation between the above indexes in IBS-D group was analyzed. Results the scores of IBS symptom severity scale, Hamilton anxiety scale, Hamilton depression scale, Hamilton Depression scale and visceral sensitivity index in the control group were significantly higher than those in the control group (P 0.01). In visceral sensitivity test, the maximal tolerance threshold of rectal dilatation in IBS-D group was significantly lower than that in control group (P 0.01). There was no significant difference in initial sensory threshold and continuous defecation threshold between the two groups (P 0.05). In IBS-D group, the total ANF score, parasympathetic score and abnormal ratio of ANF in IBS-D group were significantly higher than those in control group (all P0.05%). In IBS-D group, VSI and Dao were positively correlated with IBSSSS (r = 0.528, 0.575, 0.507, P 0.01, r = 0.636, 0.476,0.697P0.01, r = 0.636, 0.476,0.697P0.01, respectively), and were negatively correlated with IBS-SSS (r = 0.636, 0.476,0.697P0.01, respectively), and were significantly negatively correlated with IBS-SSS (r = 0.636, 0.476,0.697P0.01, r = 0.476,0.697P0.01, respectively). There was no correlation between HAMA-HAMD-VSI and serum DAO (both P0.05 + ANF and other indexes). Conclusion there are psychosomatic disorders, visceral hypersensitivity, intestinal barrier damage and ANF disorder with parasympathetic nerve dysfunction in patients with WIBS-D. The first three factors are related to the severity of the disease and may play an important role in the pathophysiology of IBS-D.
【作者单位】：中国医学科学院北京协和医学院研究生院;中日友好医院消化内科;山东大学附属济南市中心医院消化内科;
【基金】：“十二五”国家科技支撑计划(2014BAI08B02)~~
【分类号】：R574.4

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