本文選題：腸易激綜合征 + 腸道清潔��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:腸道清潔是腸鏡檢查前腸道準(zhǔn)備的常規(guī)操作,本文將腸道清潔對腹瀉型腸易激綜合征(D-IBS)患者相關(guān)癥狀及腸道菌群的影響進行了初步研究,為腸道清潔在腸易激綜合征中的作用提出新看法,為輔助治療和預(yù)防腸易激綜合征提供新思路。方法:嚴(yán)格按照納入和排除標(biāo)準(zhǔn)選擇山西醫(yī)科大學(xué)附屬人民醫(yī)院消化科腸鏡檢查者40例(其中D-IBS患者20例,無明顯癥狀對照20例),依據(jù)患者自述對清潔前、清潔后及腸鏡檢查12個月后癥狀進行評分比較,并應(yīng)用實時熒光定量PCR(real-time PCR)技術(shù)對腸道11種優(yōu)勢定植菌在清潔前糞便、清潔后糞便及降結(jié)腸黏膜組織中的含量進行定量檢測,使用兩獨立樣本t檢驗的方法比較組間差異,使用Spearman’s進行相關(guān)性分析。結(jié)果:患者自述腸道清潔后D-IBS癥狀明顯好轉(zhuǎn),癥狀評分明顯減少,緩解期明顯延長,檢查前期頻繁發(fā)作現(xiàn)象明顯得到改善;糞便菌群變化特點:清潔前D-IBS組糞便中害肺戴阿里斯特桿菌(Dialister Pneumosintes,D.Pne)明顯增多(P0.05);清潔后D-IBS組與對照組糞便中D.Pne差異消失,擬桿菌門(Bacteroidetes,Bac)較對照組糞便中明顯減少(P0.05);降結(jié)腸黏膜組織菌群變化特點:Bac,擬桿菌-普雷沃氏菌(Bacteriodes Prevotella,B.Pre)及梭菌屬(Clostridium,Sg)較對照組明顯減少(P0.05);糞便及降結(jié)腸黏膜組織中雙歧桿菌(Bifidobacterium,Bif),大腸桿菌(Enterococcus,E coli),致病性大腸桿菌(Enteropathogenic E coli,EPEC),柔嫩梭菌(Faecalibacterium prausnitzii,F.Pra),厚壁菌門(Firmicutes,Firm),乳桿菌(Lactobacillus,Lac),沙門菌(Salmonella spp,Sal)無明顯變化(P0.05)。細(xì)菌間相關(guān)性分析顯示:結(jié)腸黏膜組織中乳桿菌、梭菌、普拉梭菌之間呈現(xiàn)正相關(guān),而乳桿菌和雙歧桿菌呈負(fù)相關(guān);糞便中沙門氏菌、大腸埃希菌含量與降結(jié)腸黏膜中該菌含量呈正相關(guān)。結(jié)論:D-IBS患者與正常人群腸道糞便及黏膜菌群均存在差異,二者特點不同,腸道清潔后糞便菌群更接近腸黏膜菌群特點,腸道清潔可緩解癥狀且達(dá)到較為長期的緩解,可能與腸道清潔后菌群重建及對糞便致病菌及時清除減少定植有關(guān),腸道清潔有望作為一種新的輔助治療手段長期有效緩解IBS癥狀。共生菌之間也可能存在協(xié)同、拮抗作用;一些致病菌群腸腔內(nèi)含量可能影響該菌在腸黏膜上的定植。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574.4

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