肠道清洁对腹泻型肠易激综合征患者临床症状及肠道菌群影响的初步研究

发布时间：2018-06-24 05:49

本文选题：肠易激综合征 + 肠道清洁　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:肠道清洁是肠镜检查前肠道准备的常规操作,本文将肠道清洁对腹泻型肠易激综合征(D-IBS)患者相关症状及肠道菌群的影响进行了初步研究,为肠道清洁在肠易激综合征中的作用提出新看法,为辅助治疗和预防肠易激综合征提供新思路。方法:严格按照纳入和排除标准选择山西医科大学附属人民医院消化科肠镜检查者40例(其中D-IBS患者20例,无明显症状对照20例),依据患者自述对清洁前、清洁后及肠镜检查12个月后症状进行评分比较,并应用实时荧光定量PCR(real-time PCR)技术对肠道11种优势定植菌在清洁前粪便、清洁后粪便及降结肠黏膜组织中的含量进行定量检测,使用两独立样本t检验的方法比较组间差异,使用Spearman’s进行相关性分析。结果:患者自述肠道清洁后D-IBS症状明显好转,症状评分明显减少,缓解期明显延长,检查前期频繁发作现象明显得到改善;粪便菌群变化特点:清洁前D-IBS组粪便中害肺戴阿里斯特杆菌(Dialister Pneumosintes,D.Pne)明显增多(P0.05);清洁后D-IBS组与对照组粪便中D.Pne差异消失,拟杆菌门(Bacteroidetes,Bac)较对照组粪便中明显减少(P0.05);降结肠黏膜组织菌群变化特点:Bac,拟杆菌-普雷沃氏菌(Bacteriodes Prevotella,B.Pre)及梭菌属(Clostridium,Sg)较对照组明显减少(P0.05);粪便及降结肠黏膜组织中双歧杆菌(Bifidobacterium,Bif),大肠杆菌(Enterococcus,E coli),致病性大肠杆菌(Enteropathogenic E coli,EPEC),柔嫩梭菌(Faecalibacterium prausnitzii,F.Pra),厚壁菌门(Firmicutes,Firm),乳杆菌(Lactobacillus,Lac),沙门菌(Salmonella spp,Sal)无明显变化(P0.05)。细菌间相关性分析显示:结肠黏膜组织中乳杆菌、梭菌、普拉梭菌之间呈现正相关,而乳杆菌和双歧杆菌呈负相关;粪便中沙门氏菌、大肠埃希菌含量与降结肠黏膜中该菌含量呈正相关。结论:D-IBS患者与正常人群肠道粪便及黏膜菌群均存在差异,二者特点不同,肠道清洁后粪便菌群更接近肠黏膜菌群特点,肠道清洁可缓解症状且达到较为长期的缓解,可能与肠道清洁后菌群重建及对粪便致病菌及时清除减少定植有关,肠道清洁有望作为一种新的辅助治疗手段长期有效缓解IBS症状。共生菌之间也可能存在协同、拮抗作用;一些致病菌群肠腔内含量可能影响该菌在肠黏膜上的定植。
[Abstract]:Objective: intestinal cleaning is a routine procedure for intestinal preparation before enteroscopy. The effects of intestinal cleaning on symptoms and intestinal flora in patients with diarrhea irritable bowel syndrome (D-IBS) were studied. To provide new ideas for the role of intestinal cleaning in irritable bowel syndrome and to provide new ideas for adjuvant treatment and prevention of irritable bowel syndrome. Methods: according to the criteria of inclusion and exclusion, 40 patients (20 D-IBS patients and 20 asymptomatic controls) were selected from the Department of Digestive tract, people's Hospital affiliated to Shanxi Medical University. After cleaning and 12 months after colonoscopy, the symptom scores were compared, and the contents of 11 dominant colonizing bacteria in feces before cleaning, in feces after cleaning and in descending colon mucosa were quantitatively detected by real-time fluorescence quantitative polymerase chain reaction (real-time PCR). Two independent samples t test were used to compare the differences between groups, and Spearmans was used for correlation analysis. Results: the symptoms of D-IBS were obviously improved, the symptom score was obviously decreased, the remission period was prolonged, and the frequent seizures in the early stage of examination were obviously improved. The fecal flora of D-IBS group increased significantly before cleaning (P0.05), and the difference of D.Pne between D-IBS group and control group disappeared after cleaning. BacteroidetesBac significantly decreased compared with the control group (P0.05), and the microflora of the descending colon mucous membrane of Bacillus, Bacteriodes Prevotella-B.Prere and Clostridium Sg decreased significantly compared with the control group (P0.05), and the bifidobacterium in feces and colonic mucosal tissues decreased significantly (P0.05), and the microflora of Bacteriodes Prevotella-B.Pre and Clostridium Sg decreased significantly compared with the control group (P0.05). Bifidobacterium bif, Enterococcus coli), Faecalibacterium prausnitzii F. Pra, Firmicuteschus Firm, Lactobacillus Lac and Salmonella sppSal showed no significant changes (P0.05). The correlation analysis of bacteria showed that there was a positive correlation among Lactobacillus, Clostridium and Clostridium praziae in colonic mucosa, but negative correlation between Lactobacillus and Bifidobacterium, salmonella in feces, The content of Escherichia coli was positively correlated with the content of Escherichia coli in the descending colon mucosa. Conclusion there are differences in feces and mucosal microflora between the two groups. The fecal microflora is closer to the intestinal mucosal microflora after intestinal cleaning, and intestinal cleaning can relieve the symptoms and achieve long-term remission. It may be related to the reconstruction of bacterial flora after intestinal cleaning and the reduction and colonization of fecal pathogenic bacteria. Intestinal cleaning is expected to be a new adjuvant therapy to alleviate the symptoms of IBS for a long time. There may also be synergistic and antagonistic effects among symbiotic bacteria, and the intestinal cavity contents of some pathogenic bacteria may affect the colonization of the bacteria on the intestinal mucosa.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.4

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