肥大细胞活化及类胰蛋白酶的变化对IBS-D的作用研究

The effects of mast cell activation and changes of tryptase on IBS-D

目的研究肥大细胞的激活及类胰蛋白酶对腹泻型肠易激综合征(IBS-D)发病机制的作用。方法回顾性分析在消化科接受治疗的30例IBS-D患者的临床资料,其均符合RomeⅢ诊断标准,同时并以结肠镜和病理检查均正常的健康体检者15例为对照组。对获取样本经石蜡包埋后采用免疫组化方法分析肥大细胞(MC)的活化比例,通过统计学分析肥大细胞的数量、活化率、平均光密度组及类胰蛋白酶的变化与患者胃肠道症状评分(GSRS)的相关性。结果 IBS-D组患者结肠黏膜中被激活的MC数量、MC活化率平均光密度值明显高于对照组(P<0.05)。MC活化百分率与GSRS评分、疼痛程度呈正相关(r值分别为0.642、0.798,P<0.05),类胰蛋白酶表达水平与GSRS评分、疼痛程度、大便性状异常的频度呈正相关(r值分别为0.731、0.645、0.421,P<0.05)。结论 IBS-D患者结肠黏膜肥大细胞活化率上升,可分泌较多的类胰蛋白酶,对IBS-D发病有刺激作用。

Objective To investigate the role of mast cell（MC） activation and tryptase in the pathogenesis of diarrhea-predominant irritable bowel syndrome（IBS-D）. Methods The clinical data of 30 patients with IBS-D who were treated in Department of Gastroenterology of our hospital were retrospectively analyzed. All the patients met the diagnostic criteria of Rome Ⅲ. At the same time,15 healthy subjects with normal results after colonoscopy and pathological examination were served as control group. Paraffin-embedded samples were used to analyze the activation ratio of MC by immunohistochemistry. Moreover,the correlation between Gastrointestinal Symptom Rating Scale（GSRS） and the number of MC,activation rate,mean optical density（OD）,and tryptase changes was analyzed statistically. Results The number of activated MC and mean OD of MC activation in colonic mucosa of patients with IBS-D were significantly higher than those in control group（P〈0. 05）. The percentage of MC activation was positively correlated with GSRS scores and pain degree（r =0. 642,0. 798 respectively,P〈0. 05）. In addition,there was a positive correlation between tryptase expression levels and GSRS scores,pain levels,and the frequency of stool abnormalities（r = 0. 731,0. 645,0. 421,respectively,P〈0. 05）.Conclusion In patients with IBS-D,the activation rate of MC in colonic mucosa is increased,which can secrete more tryptase and has stimulatory effects on the pathogenesis of IBS-D.