不同亚型肠易激综合征患者肠道机械屏障的改变

Changes of intestinal mucosal mechanical barrier in patients with irritable bowel syndrome

目的:观察不同亚型肠易激综合征(IBS)患者肠黏膜机械屏障的变化,探讨这些改变在IBS发病中的可能作用和临床意义。方法:按照罗马Ⅲ标准选取腹泻型(IBS-D组)、便秘型(IBS-C组)及混合型(IBS-M组)IBS患者及正常对照组各20例,检测其结肠黏膜标本及血清D-乳酸、DAO水平,并对比分析。结果:对照组微绒毛高度、肠腺深度、黏膜厚度均显著大于各亚型IBS患者(P<0.01),且不同亚型IBS患者中以IBS-D组上述指标减低最为明显。血清D-乳酸、DAO水平IBS-D组均较其他三组显著升高(P<0.01),而IBS-M组DAO水平也较IBS-C组和对照组有着明显升高(P<0.05)。结论:肠黏膜机械屏障受损在腹泻型IBS的发病中起着更为重要的作用,肠黏膜通透性增高与腹泻症状密切相关。

Objective： To investigate the changes of intestinal mucosal mechanical barrier in patients with different subtype irritablebowel syndrome（IBS）, and explore the role of these changes in the pathogenesis of IBS. Methods： IBS and its three subtypes were diagnosedaccording to the Rome Ⅲ. In 20 healthy controls, 20 patients with diarrhea-predominant IBS（IBS-D）, 20 patients with constipation-predomi-nant IBS（IBS-C） and 20 patients with mixed bowel habits IBS（IBS-M）, colonic mucosa and D-lactate, DAO in the serum were analyzed. Results：The height of microvilli, the density of enteraden and the mucosal thickness of colon in control group was significantly greater than thosein the IBS groups（P〈0.01）. These indicators in IBS-D group reduced remarkably than that in the other two groups. The serum levels of D-lactate and DAO in IBS-D group were significantly higher than those in the other three groups（P〈0.01）. The serum level of DAO in IBS-M groupwas significantly increased than it in IBS-C group and control group. Conclusion： Impaired intestinal mucosal mechanical barrier plays amore important role in the pathogenesis of IBS-D. The increase of intestinal mucosal permeability is closely related to the symptoms of diarrhea.