腹泻型肠易激综合征重叠功能性消化不良与精神心理、胃肠激素的相关性

Correlation between diarrhea type irritable bowel syndrome overlapped with functional dyspepsia andpsychology and gastrointestinal hormones

目的探讨腹泻型肠易激综合征（IBS）重叠功能性消化不良（FD）患者精神心理状况及其与脑肠肽、细胞因子水平差异的相关性。方法选取190例腹泻型IBS重叠FD患者及30名健康对照者完成临床问卷，并应用成人心理测验系统进行SCL-90心理测评，随机抽取其中59例患者检测血浆5-羟色胺、生长抑素（SS）、血管活性肠肽（VIP）、内皮素及IL-10等水平。统计学处理采用单因素方差分析和LSD检验。结果腹泻型IBS重叠FD患者中，腹泻型IBS为主和FD为主患者血浆5-羟色胺水平分别为（1906．83±676．88）μg／L和（1745．53±653．23）μg／L，均高于对照组的（1289．44土918．45）μg／L（LSD检验，P均〈0．05），VIP、IL-10水平均低于对照组（LSD检验，P均〈0．01）。腹泻型IBS为主患者血浆SS水平低于对照组（LSD检验，P=0．025），内皮素水平高于对照组及FD为主患者（LSD检验，P均〈0．05）。腹泻型IBS重叠FD患者焦虑、抑郁、敌对量表评分均高于对照组（F=5．114、4．555、10．285，P均〈0．05）。合并抑郁和（或）焦虑状态患者血浆VIP、SS水平低于对照组（LSD检验，P均〈0．05），VIP水平亦低于无相应心理异常患者（LSD检验，P=0．005）。病程〉5年患者血浆内皮素水平高于病程〈1年及1-5年患者（LSD检验，P均〈0．05），IL-10水平低于病程〈1年患者（LSD检验，P=0．004）。结论腹泻型IBS重叠FD患者存在心理亚健康状态，其症状重叠可能与病程、精神心理异常和血浆5-羟色胺水平升高、IL-10水平降低有关；血浆VIP、SS水平降低及内皮素水平升高可能与本病的下消化道症状密切相关。

Objective To investigate the psychological status of diarrhea type irritable bowel syndrome （D-IBS） patients overlapped with functional dyspepsia （FD） and its relationship with the changes of brain-gut peptides and cytokines levels. Methods A total of 190 D-IBS-FD overlapped patients and 30 healthy controls were selected and all of them completed the questionnaire. The adult psychological testing system was applied for the Symptom Checklist （SCL-90） assessment. Plasma levels of 5-hydroxytryptamine （5-HT）, somatostatin （SS）, vasoactive intestinal peptide （VIP）, endothelin （ET）, interleukin （IL）-10 and IL-12 were measured in 59 randomly selected patients.Single factor analysis of variance and LSD test were performed for statistical analysis. Results In D- IBS-FD overlapped patients, the plasma 5-HT levels of the D-IBS patients and the FD patients were （1906.83±676. 88） μg/L and （1745. 53±653. 23） μg/L respectively, both of them were significant higher than those of control group [（1289.44±918.45） μg/L, LSD test, both P〈0. 051. However the levels of VIP and IL-10 were significant lower than those of control group （LSD test, both P〈0.01）. In D-IBS patients, the plasma level of SS was significantly lower than that of control group （LSD test, P=0. 025） ; the level of ET was significantly higher than that of control group and FD patients （LSD test, both P〈0. 05）. In D-IBS-FD overlapped patients, the scores of anxiety, depression and opponent were higher than those of control group （F=5. 114, 4. 555 and 10. 285, all P〈0.05）. The plasma VIP and SS levels of patients with anxiety or depression were lower than those of control group （LSD test, both P〈0.05）. The plasma VIP level was lower than that of patients without psychological disorders （LSD test, P=0. 005）. The plasma ET level of patients with disease course over five years was significantly higher than that of patients with disease course less than one year or between one and five years （LSD test, both P〈0.05）, and the IL-10 level was significantly lower than that of patients with disease course less than one year （LSD test, P=0. 004）. Conclusions There were sub-healthy psychology state in D-IBS-FD overlapped patients. The overlapping symptoms may be correlated with disease course, psychological disorder, the increased plasma 5-HT level and the decreased IL-10 level. There was close correlation between the lower gastrointestinal symptoms and the decreased levels of VIP, SS and the increased level of ET.