感染后肠易激综合征与非感染后肠易激综合征临床差异分析

An analysis for the clinical difference between post infectious irritable bowel syndrome and non post infectious irritable bowel syndrome

目的 探讨感染后肠易激综合征（PI-IBS）与非感染后肠易激综合征（NPI-IBS）的临床差异.方法 收集解放军总医院2010年至2013年确诊并治疗的PI-IBS患者（PI-IBS组）117例、非感染后IBS患者（NPI-IBS组）201例,以及31例健康体检人员（健康对照组）的临床资料和治疗前血清样本,分析各组临床特征和血清肠脂肪酸结合蛋白（I-FABP）水平的差异.结果 （1）PI-IBS组患者的IBS发病至就诊时间长于NPI-IBS组[（19.7±10.3）个月比（11.4±5.3）个月,P＜0.05],伴焦虑状态[焦虑自评量表（SAS）评分＞50分]的比例明显高于NPI-IBS组[58.1％ （68/117）比28.9％（58/201）,P＜0.05];两组的男女性别比、发病年龄、IBS分型、胃肠道症状分级量表（GSRS）评分的差异无统计学意义.（2） PI-IBS组血清I-FABP水平明显高于NPI-IBS组和健康对照组[（42.6±14.8）μg/L比（17.3 ±11.5）μg/L和（10.6±8.2） μg/L,P均＜0.05],NPI-IBS组和健康对照组的血清I-FABP水平无明显差异（P＞0.05）.（3）PI-IBS组腹泻型IBS（IBS-D亚型）患者血清I-FABP水平明显高于NPI-IBS组IBS-D亚型患者[（54.8 ±9.3）μg/L比（12.3±6.2） μg/L,P＜0.05],两组间便秘型IBS（IBS-C亚型）和混合型IBS（IBS-M亚型）患者的血清I-FABP水平无明显差异（P均＞0.05）.结论 PI-IBS患者病程长、多伴有焦虑状态,且存在隐匿性肠道炎症,伴有肠黏膜上皮损伤.血清I-FABP有望成为PI-IBS检测指标.

Objective To study the clinical discrepancy between patients with post infectious irritable bowel syndrome（PI-IBS） and non post infectious irritable bowel syndrome（NPI-IBS）,and assess the value of serum intestinal fatty acid binding protein （I-FABP） for differential diagnosis.Methods A total of 117 patients with PI-IBS,201 patients with NPI-IBS and 31 healthy controls were prospectively recruited in General Liberation Army Hospital from 2010 to 2013.Plasma samples and clinical data were collected.Serum I-FABP level was measured by an enzyme-linked immunosorbent assay.Results The median age of patients with PI-IBS was 36 years.The median time to diagnosis in PI-IBS group was significantly longer than that in NPI-IBS group [（19.7 ± 10.3） months vs （11.4 ± 5.3） months,P 〈 0.05].Similarly,the proportion of anxiety [58.1% （68/117） vs 28.9% （58/201）,P 〈 0.05] and the value of I-FABP[（42.6 ± 14.8） μg/L vs （17.3 ± 11.5） μg/L,P 〈 0.05] in PI-IBS group were significant higher than NPI-IBS patients.The level of I-FABP of healthy controls [（10.6 ± 8.2） μg/L] was also significantly lower than that of PI-IBS patients （P 〈 0.05）,yet no difference from that of NPI-IBS group.The I-FABP value of subgroup PI-IBS patients with diarrhoea （IBS-D） was significant higher than that of NPI-IBS group [（54.8 ± 9.3） μg/L vs （12.3 ± 6.2） μg/L,P 〈 0.05].However,other parameters including gender,age,GSRS score,and I-FABP value of subgroup constipation （IBS-C） and mix （IBS-M）,were not different between PI-IBS group and NPI-IBS group （all P 〉 0.05）.Conclusion PI-IBS is an occult intestinal inflammation disease with mucosa injury.I-FABP might be a potential testing marker for the diagnosis of PI-IBS.