肠道感染与肠易激综合征

Intestinal infection and irritable bowel syndrome

目的 探讨肠道急性感染与肠易激综合征 (IBS)的关系。方法 对患病前无肠功能紊乱的 2 95例痢疾 /肠炎患者 (2 35例为细菌性痢疾 )及 2 43例未曾患过痢疾 /肠炎的配偶或兄弟姐妹 (对照组 )进行随访。检测了 30例IBS患者及 12例对照组末端回肠、直肠与乙状结肠交界处肠黏膜内白细胞介素 (IL) 1α、IL 1β、IL 1ra的mRNA表达。 结果 患过痢疾 /肠炎者 1～ 2年内 6 6例 (2 2 4% )有持续的肠功能紊乱 ,2 4例 (占痢疾病人的 10 2 % )发展为IBS。对照组肠功能紊乱的患病率为 7 4% ,IBS的患病率为 0 8%。其中痢疾 /肠炎病程长者 ,发生肠功能紊乱的危险度高 ,8～ >15d的OR =3 5～4 6。有痢疾 /肠炎史的IBS患者末端回肠、直肠与乙状结肠交界处肠黏膜IL 1βmRNA的表达增高。

Objective To determine whether intestinal infection plays a role on the pathogenesis of irritable bowel syndrome (IBS). Methods 295 patients who had no previous history of functional bowel disorder had received treatment for dysentery (n=235) or for acute bowel infection at the hospital between April-October, 1998 ,were followed up for 1-2 years and evaluated for their subsequent bowel habits. A cohort study of 243 subjects using their siblings, husbands or wives who did not have dysentery or acute bowel infection at the same period was taken as control. Furthermore, the contents of mRNAs of IL-1α?IL-1β and IL-1ra in the mucosa at the terminal ileum and recto-sigmoid junctions were determined and compared using RT-PCR method in 30 IBS patients and 12 controls. Results (1)Sixty-six (22.4%) patients were reported to have functional bowel disturbance, and 24(8.1% total and 10.2% among cases of dysentery ) developed IBS in the study group, whereas, only 7.4% had altered bowel habit and 0.8% had IBS in the control group(P<0.01). (2)The risk of having functional bowel disturbance was higher in patients who suffered from a longer duration (>8 d, OR=3.5)of dysentery. (3)The IL-1β mRNA level in the mucosa of terminal ileum and recto-sigmoid junction of IBS patients with dysentery was higher than that of controls and IBS patients without dysentery (P<0.01).Conclusion Intestinal infection plays a role on the pathogenesis of IBS through some immunological factors.