本文關(guān)鍵詞： 腸易激綜合征 焦慮 抑郁 細(xì)胞因子　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的:腸易激綜合征(IBS)是一種常見(jiàn)的腸道功能性疾病,為全球多發(fā)病,雖然此病不威脅患者的生命,但由于病程長(zhǎng),易反復(fù),不僅影響了患者的生活質(zhì)量還增加了患者的經(jīng)濟(jì)負(fù)擔(dān)。目前腸易激綜合征的發(fā)病機(jī)制尚不明確,認(rèn)為可能與精神心理因素、胃腸道的感染、腦-腸軸功能失調(diào)及腸道免疫功能異常等有關(guān)。已有研究表明腸道持續(xù)低度炎癥是腸易激綜合征的重要病理生理表現(xiàn),但不同的研究尚存在爭(zhēng)議,且IBS亞組中,感染后腸易激綜合征(PI-IBS)和非感染后腸易激綜合征(NPI-IBS)是否存在差異也尚不明確。因此,本研究根據(jù)有無(wú)胃腸道感染史將IBS患者分為PI-IBS和NPI-IBS組。通過(guò)評(píng)估PI-IBS和NPI-IBS患者胃腸道癥狀及焦慮和抑郁情況了解其臨床特征,同時(shí)通過(guò)檢測(cè)IBS患者及正常對(duì)照者外周血和腸黏膜中IL-17A,IFN-γ和IL-10的表達(dá)情況,探討IBS患者促炎細(xì)胞因子和抗炎細(xì)胞因子的表達(dá)及IBS亞組之間是否存在差異,為以后IBS發(fā)病機(jī)制的研究提供依據(jù)。方法:按照羅馬Ⅲ診斷標(biāo)準(zhǔn)納入腹瀉型IBS患者44例(PI-IBS 21例,NPI-IBS 23例),健康對(duì)照者10例,采用GSRS,SAS,SDS量表評(píng)估腸易激綜合征患者胃腸道癥狀、焦慮及抑郁狀態(tài)。腸鏡下鉗取回盲部及直腸黏膜標(biāo)本,免疫組化法檢測(cè)IL-17A,IFN-γ和IL-10的表達(dá)。采集兩病例組及健康對(duì)照組肘靜脈血,離心后取上層血清,ELISA法檢測(cè)外周血IL-17A,IFN-γ和IL-10的表達(dá)。研究結(jié)果:1.PI-IBS組SAS評(píng)分較對(duì)照組和NPI-IBS組顯著升高(P0.05),NPI-IBS組SAS評(píng)分稍高于對(duì)照組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);PI-IBS組SDS評(píng)分高于對(duì)照組和NPI-IBS組(P0.05),NPI-IBS組高于對(duì)照組(P0.05);PI-IBS組GSRS評(píng)分顯著高于NPI-IBS組(P0.05)。2.與對(duì)照組相比,PI-IBS組和NPI-IBS組回盲部和直腸IL-17A,IFN-γ的表達(dá)升高,IL-10的表達(dá)降低(P0.05)。3.血清中PI-IBS組IL-17A的表達(dá)較對(duì)照組升高(P0.05);IFN-γ的表達(dá)在三組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);PI-IBS組和NPI-IBS組IL-10的表達(dá)較對(duì)照組降低(P0.05);PI-IBS與NPI-IBS組之間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.腸黏膜和外周血中細(xì)胞因子的表達(dá)呈一致性變化,我們還發(fā)現(xiàn)PI-IBS組IL-17A和IFN-γ的表達(dá)較NPI-IBS組稍高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。研究結(jié)論:1.PI-IBS和NPI-IBS患者存在不同程度的焦慮和抑郁表現(xiàn)。2.PI-IBS和NPI-IBS外周血和腸黏膜中IL-17A和IFN-γ的表達(dá)升高,IL-10表達(dá)降低。3.PI-IBS組和NPI-IBS組患者都存在腸道低度炎癥,但PI-IBS患者臨床癥狀較NPI-IBS患者重,細(xì)胞因子的改變更明顯,PI-IBS可能與NPI-IBS有不同的發(fā)病機(jī)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- 緯 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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