腹泻型肠易激综合征合并功能性消化不良肝郁脾虚证与胃肠激素相关性研究

A Correlation Study between Diarrhea-predominant Irritable Bowel Syndrome Complicated Functional Dyspepsia Patients of Gan-stagnation Pi-deficiency Syndrome and Gastrointestinal Hormones

目的探讨腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,D-IBS)合并功能性消化不良(functional dyspepsia,FD)肝郁脾虚证病机与症状、精神心理及胃肠激素的相关性。方法采用罗马Ⅲ标准和中医辨证标准,选取111例诊断为D-IBS合并FD肝郁脾虚证患者为研究对象,并以30名健康志愿者作为对照,采用问卷调查的形式记录受访者的一般情况、消化道症状评分及肝郁脾虚证亚型分布,并应用北京惠诚成人心理测验软件完成90项症状自评量表(symptom check list-90,SCL-90)心理测评,同时检测血浆脑肠肽5-羟色胺(5-hydroxytryptamine,5-HT)、生长抑素(somatostatin,SS)、血管活性肠肽(vasoactive intestinal peptide,VIP)、内皮素(endothelin,ET)及炎症细胞因子白介素10(interleukin 10,IL-10)、白介素12(interleukin 12,IL-12)水平。结果 (1)D-IBS合并FD肝郁脾虚证各亚型分布以脾气虚亚型比例最高(51/111,45.9%),脾阳虚亚型次之(34/111,30.6%);三个亚型间消化道症状评分比较,差异无统计学意义(P>0.05)。(2)与对照组比较,D-IBS合并FD肝郁脾虚证三亚型焦虑因子评评分及总症状指数均显著升高,脾阳虚亚型及肝郁亚型抑郁因子评分亦显著升高(P<0.05,P<0.01),肝郁亚型抑郁因子分显著高于脾气虚亚型(P<0.01);D-IBS合并FD肝郁脾虚证患者无论是否合并焦虑和(或)抑郁,血浆5-HT水平均显著高于对照组,VIP、IL-10水平均显著低于对照组(P<0.05),合并焦虑和(或)抑郁患者血浆VIP水平亦显著低于无明显心理异常患者(P<0.01),SS水平显著低于对照组(P<0.05);各患者组血浆ET及IL-12水平与对照组比较,差异无统计学意义(P>0.05)。(3)与对照组比较,D-IBS合并FD肝郁脾虚证各亚型血浆5-HT水平显著升高,VIP及IL-10水平显著下降(P<0.05,P<0.01),SS、ET及IL-12水平无显著改变(P>0.05);此外,肝郁亚型患者血浆5-HT水平显著高于脾阳虚亚型,VIP水平显著低于脾气虚亚型(P<0.05)。结论 D-IBS合并FD肝郁脾虚证病机有肝郁、脾虚主次之分,精神心理异常及血浆5-HT水平升高、VIP水平降低可能与肝郁亚型关系密切,这为本病的中西医结合治疗及探寻中医证型客观化指标提供了一定参考。

Objective To investigate the correlation between the pathogeneses of diarrhea-pre- dominant irritable bowel syndrome （D-IBS） complicated functional dyspepsia （FD） patients of Gan-stagnation Pi-deficiency Syndrome （GSPDS） and symptoms, psychological states, and gastrointestinal hormones. Methods A total of 111 patients with confirmed D-IBS complicated FD of GSPDS were recruited as the treated group by using Rome Ⅲ standard and Chinese medical syndrome standard. And 30 healthy volunteers were recruited as the control group. The general condition, scoring for digestive symptoms, and the distribution of GSPDS subtype of all subjects were recorded by a questionnaire, and assessed bySymptom Checklist （SCL-90; a software for psychological test developed by Beijing Huicheng Adult Corporation）. Meanwhile, plasma levels of 5-hydroxytryptamine （5-HT）, somatostatin （SS）, vasoactive intestinal peptide （VIP）, endothelin （ET）, interleukin 10 （IL-10）, and interleukin 12 （IL-12） were measured in all subjects. Results （1） The subtype of D-IBS complicated FD of GSPDS was dominant in Pi-qi deficiency type （51/111,45.9% ）, Pi yang deficiency type （34/111,30.6% ）, and GSPDS. There was no statistical difference in the scoring of digestive symptoms among the 3 subtypes （P 〉0.05）. （2） Compared with the control group, the anxiety factor score and the total score significantly increased in all three sub- types of D-IBS complicated FD of GSPDS, and the depression score of Pi yang deficiency type and Gandepression type also significantly increased （P 〈0.05, P 〈0.01 ） ; the depression score of Gan-depression type was significantly higher than that of the Pi-qi deficiency type （P 〈0.01 ）. Plasma 5-HT levels were obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities, and VIP and IL-10 levels were significantly low- er than those in the control group （P 〈0.05）. Plasma VIP levels were also obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities （P 〈0.01 ）, and SS levels were significantly lower than those in the control group （P 〈0.05）. There was no statistical difference in plasma ET or IL-12 levels in each patient group, when compared with the control group （P 〉0.05）. （3） Compared with the control group, plasma 5-HT levels significantly increased, plasma VIP and IL-10 levels significantly decreased in ach subtype of D-IBS complicated FD patients of GSPDS （P 〈0.05, P 〈0.01 ）, and no significant change of SS, ET, or IL-12 occurred （P 〉0.05）. Besides, plasma 5-HT levels were significantly higher in Gan-depression type than in Pi yang deficiency type, VIP levels were lower in Gan-depression type than in Pi-qi deficiency type （all P 〈0.05）. Conclusions Gan stagnation and Pi deficiency were dominant in DABS complicated FD patients of GSPDS. Psychological abnormalities, increased plasma 5-HT levels, and decreased plasma VIP levels were closely correlated with Gan stagnation subtype, which provided some reference for looking for objective indicators of Chinese medical syndromes in treating D-IBS complicated FD patients of GSPDS.