發(fā)布時間：2018-03-25 11:03

  本文選題：腹瀉型腸易激綜合征　切入點：胃食管反流病　出處：《揚州大學》2017年碩士論文

【摘要】：腸易激綜合征(Irritable bowel syndrome,IBS)和胃食管反流病(gastroesophag-eal reflux disease,GERD)都是消化系統(tǒng)的兩種常見病。大量國內(nèi)外流行病學調(diào)查研究顯示這兩種病都具有較高的發(fā)病率,并且癥狀易發(fā)生重疊,GERD患者經(jīng)常伴有IBS癥狀樣腹瀉,而IBS的某些腸外癥狀也是GERD的典型表現(xiàn)。兩者共同的病因可能是遺傳、心理因素、激素、非類固醇類抗炎藥及膽道疾病,共同的病理生理機制可能是內(nèi)臟感覺異常、胃腸動力異常和神經(jīng)系統(tǒng)功能的異常。中醫(yī)學認為氣機暢通是人體正�；顒颖夭豢缮俚臈l件之一,脾胃升降功能失常,胃氣上逆則發(fā)生反酸、呃逆。肝與大腸相通,腸道氣機不暢,傳導失常,則發(fā)生泄瀉,兩種疾病的發(fā)生皆與“氣”有密切的關系。本研究以D-IBS重疊GERD患者為研究對象,以單純D-IBS、單純GERD及健康人為對照組,采用臨床問卷調(diào)查的方式對患者的一般情況、飲食、發(fā)病季節(jié)等進行調(diào)查,同時對重疊證患者消化道癥狀進行評分;采用酶聯(lián)免疫吸附法(ELISA)對其中部分患者進行血漿饑餓素(Ghrelin)、瘦素(Leptin)、降鈣素基因相關肽(Calcitonin gene-related peptide,CGRP)、神經(jīng)肽 Y(Neuropeptide Y,NPY)的水平檢測。研究結(jié)果如下:1.D-IBS重疊GERD可能與病程長短有關:120例重疊證患者中,病程5年患者比例最高,為67例(55.8%),D-IBS重疊GERD患者病程構(gòu)成與單純D-IBS患者及單純GERD患者相比有統(tǒng)計學意義(P0.05)。2.D-IBS重疊GERD不同中醫(yī)證型可能與食管內(nèi)鏡下表現(xiàn)有關:120例重疊證患者中,與D-IBS重疊RE患者相比,D-IBS重疊NERD中肝氣乘脾證患者比例較其明顯升高,差異有統(tǒng)計學意義(P0.05)。3.D-IBS重疊NERD患者消化道癥狀更嚴重:與D-IBS重疊RE的患者相比,D-IBS重疊NERD的患者消化道癥狀積分顯著高于D-IBS重疊RE的患者,差異有統(tǒng)計學意義(P0.05)。4.D-IBS重疊GERD患者存在多種腦腸肽水平的異常:與健康組相比,D-IBS重疊GERD患者血漿Ghrelin水平均顯著降低(P0.05)、Leptin、CGRP水平顯著升高(P0.05);D-IBS組患者血漿NPY、Leptin水平顯著降低(P0.05、P0.01)CGRP水平顯著升高(P0.01);GERD組患者血漿Ghrelin水平下降(P0.05)、Leptin、CGRP水平顯著升高(P0.05)。5.D-IBS重疊GERD患者食管內(nèi)鏡下表現(xiàn)可能與血漿CGRP水平有關:與D-IBS重疊NERD患者相比,D-IBS重疊RE患者血漿CGRP水平顯著降低(P0.05)。6.D-IBS重疊GERD患者血漿Leptin、NPY及CGRP水平可能與中醫(yī)分型有關:80例重疊病患者中,肝氣乘脾證組血漿Leptin水平顯著高于中虛氣逆證組,差異有統(tǒng)計學意義(P0.05),肝郁脾虛證組血漿NPY、CGRP水平顯著高于脾胃虛弱證組,差異有統(tǒng)計學意義(P0.05)。結(jié)論:D-IBS重疊GERD患者的病程易遷延;D-IBS重疊NERD患者的消化道癥狀更嚴重,該亞型的發(fā)病與肝氣乘脾證有關;血漿NPY、Leptin、CGRP水平的變化可能與重疊證的發(fā)生發(fā)展有關;血漿CGRP水平的降低可能與食管粘膜受損有關;血漿Leptin、NPY和CGRP水平差異可能與中醫(yī)分型相關。
[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.
【學位授予單位】：揚州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259
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本文編號：1662835