摘要
目的比较肠易激综合征（IBS）伴精神障碍与不伴精神障碍患者的肠道黏膜炎症指标，了解炎症与IBS精神障碍共病的关系。方法顺序纳入2008年11月至2011年3月在北京大学第三医院消化科门诊就诊、符合罗马Ⅲ标准的IBS患者43例及无消化道症状的志愿者（对照组）15名，由经过培训的人员应用复合性国际诊断交谈表（CIDI）对其进行访谈；所有纳入者行结肠镜检查并取回肠末端和结肠黏膜活检组织，比较IBS不伴精神障碍（24例）及伴精神障碍（19例）患者与对照组（13名，有精神障碍者2例予以剔除）的肠黏膜活检组织CD3阳性淋巴细胞、肥大细胞、5-羟色胺阳性细胞及吲哚胺2，3．双加氧酶（IDO）阳性细胞数。结果IBS患者中任意精神障碍检出比例显著高于对照组（19／43比2／15，P=0．012），其中焦虑障碍9例，心境障碍8例。IBS伴精神障碍患者在回肠末端、乙状结肠黏膜组织的肥大细胞数及5．羟色胺阳性细胞数（每高倍视野：16．7±3．6、12．8±2．2，3．7±0．9、6．1±1．8），与IBS不伴精神障碍组（每高倍视野：15．4±3．1、12．3±2．5，3．4±0．8、5．2±1．8）相比，差异均无统计学意义（均P〉0．05）；回肠末端CD3阳性淋巴细胞、IDO阳性细胞数与IBS不伴精神障碍组差异亦均无统计学意义（均P〉0．05）。IBS伴焦虑障碍患者的回肠末端IDO计数显著高于IBS不伴精神障碍患者[中位数（Q1，Q3）：6（4，8）比2（1，5），P=0．018]。IBS伴心境障碍患者的回肠末端肥大细胞计数显著高于IBS不伴精神障碍组（每高倍视野：18．3±3．2比15．4±3．1，P=0．032）。结论IBS患者精神障碍可能与肠道黏膜炎症有一定关系；IDO激活可能与焦虑障碍共病，肥大细胞活化可能与心境障碍共病相关。
Objective To examine the relationship between inflammation and the comorbidity of mental disorders with irritable bowel syndrome （IBS） by comparing intestinal mucosa inflammatory biomarkers in patients with and without mental disorders. Methods A total of 43 consecutive IBS patients fulfilling the Rome Ⅲ criteria and 15 volunteers serving as controls without digestive symptoms were recruited and interviewed with Composite International Diagnostic Interview （CIDI） by the well-trained staff and thus classified as with or without mental disorders. All subjects underwent colonoscopy and biopsies were acquired from the mucosa of distal ileum and colon. CD3 ＋ lymphocytes, mast cells, 5-HT positive cells and （indoleamine 2,3-dioxygenase） IDO positive cells were identified immunohistologically in mucosa biopsies in volunteers （n = 13 ）, IBS patients without mental disorder （n = 24） and IBS patients with mental disorder （n = 19）. Results The incidence of mental disorders in IBS patients was significantly higher than that in the volunteers （19/43 vs 2/15, P = 0. 012） , including 9 patients with anxiety disorders and 8 with mood disorders. （ 1 ） The number of mast cells in IBS patients with mental disorder and that in IBS patients without mental disorder has no statistical significance （ （ 16. 7 ± 3.6 ）/HP vs （ 15.4 ± 3.1 ）/HP in distal ileum, （ 12. 8 ± 2. 2）/HP vs （ 12. 3 ± 2. 5 ）/HP in sigmoid, both P 〉 0. 05 ）. Similar results were seen in 5-HT positive cells（ （3.7 ±0. 9）/HP vs（3.4 ±0. 8）/HP in distal ileum, （6. 1 ±1.8）/HP vs（5.2 ± 1.8）/HP in sigmoid, both P 〉 0. 05 ）. In distal ileum, the number of CD3＋ cells in IBS patients with mental disorder has no statistical significance with that in the IBS patients without mental disorder （ （62 ± 16）/HP vs （55± 22）/HP, P 〉 0. 05 ）. Similar results were seen in IDO positive cells （6 （2,8）/HP vs 2 （ 1,5 ）/HP, P 〉 0. 05）. （2） The number of IDO positive cells from distal ileum in IBS patients with anxiety disorder was significantly higher than that in the IBS patients without mental disorder （ 6 （4, 8 ） vs 2 （ 1, 5 ）, P = 0. 018 ）. The number of mast cells from distal ileum in the IBS patients with mood disorder were significantly higher than that in those without mental disorders （ （ 18.3± 5.2 ）/HP vs （ 15.4 ± 3.1 ）/HP, P = 1. 032 ）. Conclusions Mental disorders in the IBS patients may be associated with intestinal mucosal inflammation. The activation of IDO may cause the comorbidity of IBS with anxiety disorder while the activation of mast ceils nrobablv leads to the comorbiditv of IBS with mood disorder.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第32期2247-2251,共5页
National Medical Journal of China
基金
国家高技术研究发展计划（863计划）（2007AA022423）
