腹泻型肠易激综合征重叠胃食管反流病中医证与脑肠肽相关性研究

发布时间：2018-03-25 11:03

  本文选题：腹泻型肠易激综合征　切入点：胃食管反流病　出处：《扬州大学》2017年硕士论文

【摘要】：肠易激综合征(Irritable bowel syndrome,IBS)和胃食管反流病(gastroesophag-eal reflux disease,GERD)都是消化系统的两种常见病。大量国内外流行病学调查研究显示这两种病都具有较高的发病率,并且症状易发生重叠,GERD患者经常伴有IBS症状样腹泻,而IBS的某些肠外症状也是GERD的典型表现。两者共同的病因可能是遗传、心理因素、激素、非类固醇类抗炎药及胆道疾病,共同的病理生理机制可能是内脏感觉异常、胃肠动力异常和神经系统功能的异常。中医学认为气机畅通是人体正常活动必不可少的条件之一,脾胃升降功能失常,胃气上逆则发生反酸、呃逆。肝与大肠相通,肠道气机不畅,传导失常,则发生泄泻,两种疾病的发生皆与“气”有密切的关系。本研究以D-IBS重叠GERD患者为研究对象,以单纯D-IBS、单纯GERD及健康人为对照组,采用临床问卷调查的方式对患者的一般情况、饮食、发病季节等进行调查,同时对重叠证患者消化道症状进行评分;采用酶联免疫吸附法(ELISA)对其中部分患者进行血浆饥饿素(Ghrelin)、瘦素(Leptin)、降钙素基因相关肽(Calcitonin gene-related peptide,CGRP)、神经肽 Y(Neuropeptide Y,NPY)的水平检测。研究结果如下:1.D-IBS重叠GERD可能与病程长短有关:120例重叠证患者中,病程5年患者比例最高,为67例(55.8%),D-IBS重叠GERD患者病程构成与单纯D-IBS患者及单纯GERD患者相比有统计学意义(P0.05)。2.D-IBS重叠GERD不同中医证型可能与食管内镜下表现有关:120例重叠证患者中,与D-IBS重叠RE患者相比,D-IBS重叠NERD中肝气乘脾证患者比例较其明显升高,差异有统计学意义(P0.05)。3.D-IBS重叠NERD患者消化道症状更严重:与D-IBS重叠RE的患者相比,D-IBS重叠NERD的患者消化道症状积分显著高于D-IBS重叠RE的患者,差异有统计学意义(P0.05)。4.D-IBS重叠GERD患者存在多种脑肠肽水平的异常:与健康组相比,D-IBS重叠GERD患者血浆Ghrelin水平均显著降低(P0.05)、Leptin、CGRP水平显著升高(P0.05);D-IBS组患者血浆NPY、Leptin水平显著降低(P0.05、P0.01)CGRP水平显著升高(P0.01);GERD组患者血浆Ghrelin水平下降(P0.05)、Leptin、CGRP水平显著升高(P0.05)。5.D-IBS重叠GERD患者食管内镜下表现可能与血浆CGRP水平有关:与D-IBS重叠NERD患者相比,D-IBS重叠RE患者血浆CGRP水平显著降低(P0.05)。6.D-IBS重叠GERD患者血浆Leptin、NPY及CGRP水平可能与中医分型有关:80例重叠病患者中,肝气乘脾证组血浆Leptin水平显著高于中虚气逆证组,差异有统计学意义(P0.05),肝郁脾虚证组血浆NPY、CGRP水平显著高于脾胃虚弱证组,差异有统计学意义(P0.05)。结论:D-IBS重叠GERD患者的病程易迁延;D-IBS重叠NERD患者的消化道症状更严重,该亚型的发病与肝气乘脾证有关;血浆NPY、Leptin、CGRP水平的变化可能与重叠证的发生发展有关;血浆CGRP水平的降低可能与食管粘膜受损有关;血浆Leptin、NPY和CGRP水平差异可能与中医分型相关。
[Abstract]:Irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) are two common diseases of digestive system. And the patients with overlapping symptoms are often accompanied by symptom-like diarrhea of IBS, and some of the extraintestinal symptoms of IBS are typical manifestations of GERD. The common causes of the two diseases may be heredity, psychological factors, hormones, non-steroidal anti-inflammatory drugs and biliary tract diseases. The common pathophysiological mechanism may be abnormal visceral sensation, abnormal gastrointestinal motility and abnormal nervous system function. In this study, the liver and large intestine were connected, the intestinal qi was not smooth, the conduction was abnormal, and diarrhea occurred. The occurrence of the two diseases was closely related to qi. In this study, the patients with D-IBS overlapping GERD were taken as the research objects. With simple D-IBS, simple GERD and healthy people as control group, the general situation, diet, onset season of the patients were investigated by clinical questionnaire, and the digestive tract symptoms of the patients with overlapping syndrome were scored. The plasma levels of ghrelin, leptin, calcitonin gene-related peptidea and neuropeptide Y(Neuropeptide Y(Neuropeptide were detected by Elisa in some of the patients. The results are as follows: 1. The overlapping GERD of D-IBS may be related to the duration of the disease. Of 120 patients with overlapping syndrome, The highest proportion of patients was found in 5 years, 67 patients with overlapping D-IBS GERD had significant difference compared with D-IBS patients and simple GERD patients. Different TCM syndromes of GERD with D-IBS overlap might be related to esophageal endoscopy in 120 patients with overlapping syndromes under esophageal endoscopy, compared with simple D-IBS patients and simple GERD patients, the disease course composition of 67 patients with overlapping D-IBS was significantly higher than that of patients with simple D-IBS and simple GERD. Compared with D-IBS overlapped RE patients, the proportion of patients with liver Qi and spleen syndrome in D-IBS overlapping NERD was significantly higher than that in D-IBS overlapping NERD. The difference was statistically significant (P 0.05) .3.The gastrointestinal symptoms of patients with overlapping NERD were significantly higher than those with D-IBS overlapped RE. The scores of gastrointestinal symptoms in patients with D-IBS overlapped NERD were significantly higher than those with D-IBS overlapped RE, and the gastrointestinal symptoms of patients with D-IBS overlapped RE were significantly higher than those with D-IBS overlapped RE. There were significant differences in the levels of various brain intestinal peptides in patients with overlapping GERD: compared with the control group, plasma Ghrelin levels in patients with D-IBS overlapped GERD were significantly lower than those in the control group. The levels of plasma Ghrelin in patients with P0.05 + D-IBS were significantly higher than those in patients with P0.05-IBS D-IBS. The levels of plasma NPYLeptin in patients with P0.05-IBS overlapped GERD were significantly lower than those in the control group. The level of plasma Ghrelin decreased significantly in patients with P0.01GERD. The level of plasma CGRP was significantly increased in patients with P0.05 + D-IBS overlapped GERD. 5. The endoscopic manifestations of patients with overlapping GERD might be related to plasma CGRP levels: compared with patients with overlapping D-IBS NERD, plasma CGRP levels in patients with overlapping NERD were significantly higher than those in patients with overlapped D-IBS. The decrease of plasma Leptin NPY and CGRP levels in patients with overlapping GERD may be related to TCM classification in 80 patients with overlapped diseases. The level of plasma Leptin in liver qi plus spleen syndrome group was significantly higher than that in middle deficiency qi inverse syndrome group, the difference was statistically significant (P 0.05), and the plasma Leptin level in liver stagnation spleen deficiency syndrome group was significantly higher than that in spleen and stomach asthenia group. Conclusion the course of disease is more serious in the patients with GERD overlapping with D-IBS, the pathogenesis of this subtype is related to the syndrome of liver-qi and spleen, the change of plasma NPYD-IBS GERD may be related to the occurrence and development of overlapping syndrome. The decrease of plasma CGRP level may be related to esophageal mucosal damage, and the difference of plasma CGRP and CGRP levels may be related to TCM classification.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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本文编号：1662835