感染后肠易激综合征患者临床特征和细胞因子的表达

Clinical Features and Expression of Cytokine in Post-infectious Irritable Bowel Syndrome Patients

【目的】探讨感染后肠易激综合征(PI-IBS)和非感染后肠易激综合征(NPI-IBS)患者临床特征及肠黏膜、外周血IL-17A、IFN-γ和IL-10的表达。【方法】腹泻型IBS患者44例(PI-IBS 21例,NPI-IBS 23例),健康对照者10例,采用GSRS、SAS、SDS量表评估肠易激综合征患者胃肠道症状、焦虑及抑郁状态。肠镜下取回盲部及直肠黏膜标本,免疫组化法检测IL-17A、IFN-γ和IL-10的表达。ELISA法检测外周血IL-17A、IFN-γ和IL-10的表达。【结果】NPI-IBS患者较对照组SDS评分升高(P<0.05);PI-IBS患者较对照组SAS和SDS评分升高(P<0.05);PI-IBS组较NPI-IBS组GSRS、SAS和SDS评分显著升高(P<0.05);与对照组相比,PI-IBS组和NPI-IBS组回盲部和直肠IL-17A、IFN-γ的表达升高,IL-10的表达降低(P<0.05);PI-IBS组血清中IL-17A的表达较对照组升高,IL-10的表达降低(P<0.05);肠黏膜和外周血中PI-IBS组IL-17A和IFN-γ的表达较NPI-IBS组稍高,但差异无统计学意义(P>0.05)。【结论】PI-IBS和NPI-IBS患者存在不同程度的焦虑、抑郁表现,外周血和肠黏膜中IL-17A和IFN-γ的表达升高,IL-10表达降低,但PI-IBS患者临床症状相对较重,细胞因子的改变更明显,PI-IBS可能与NPI-IBS有不同的发病机制。

【Objective】To study the clinical features and expressions of IL-17 A,IFN-γ,and IL-10 in serum and intestinal mucosa of patients with post-infectious irritable bowel syndrome and non post-infectious irritable bowel syndrome.【Methods】44 diarrhea-predominate IBS patients（21 with PI-IBS,23 with NPI-IBS）and 10 healthy controls were recruited in this study.Investigation questionnaires of GSRS,SAS,SDS were carried out to evaluate the gastrointestinal function,anxiety status and depression status of IBS patients.The expressions of IL-17 A,IFN-γ,and IL-10 in intestinal mucosa and serum were measured by immunohistochemistry（IHC）and enzyme-linked immunosorbent assay（ELISA）.【Results】The SDS scores of NPI-IBS patients were higher than those of controls（P0.05）,and the SAS and SDS scores of PI-IBS patients were higher than those of controls（P0.05）.The GSRS,SAS and SDS scores of PI-IBS group were higher than those of NPI-IBS group（P0.05）.Compared with healthy controls,PI-IBS and NPI-IBS group showed significant rise of IL-17 A,IFN-γ levels and decrease of IL-10 level in intestinal mucosa（P0.05）;In serum,the IL-17 A levels were up-regulated and the IL-10 levels were decreased in PI-IBS group but not in NPI-IBS group when compared with controls（P0.05）.In intestinal mucosa and serum,IL-17 A and IFN-γ levels in PI-IBS group were slightly higher than those in NPI-IBS group（P0.05）.【Conclusion】PI-IBS and NPI-IBS patients existed various anxiety and depression.The levels of IL-17 A and IFN-γ increased and level of IL-10 decreased in PI-IBS and NPI-IBS group.But the clinical symptoms and changes of cytokines of PI-IBS patients were more significant.There may exist other pathogenesis in PI-IBS but not in NPI-IBS.