神经-内分泌-免疫系统调控异常与肠易激综合征相关性的研究进展

Relationship Between Irritable Bowel Syndrome and Regulatory Abnormalities of Neuro-endocrine-immune Network

肠易激综合征(IBS)是临床最常见的功能性胃肠病(FGIDs)之一,其病理生理学改变尚未完全阐明,涉及遗传因素、感染后改变、慢性感染和肠道菌群紊乱、黏膜低度炎症、免疫激活与肠道通透性改变、胆汁盐代谢失调以及血清素代谢异常等。罗马Ⅳ强调IBS发生与神经胃肠病学和脑-肠互动多方面异常相关,其中神经-内分泌-免疫(NEI)系统相互交错使症状存在不均一性是其特征性表现。本文结合国内外研究进展,对基于脑-肠、肠-脑互动的自主神经功能失调、内脏高敏感性为主的神经信号,促皮质素释放因子(CRF)、皮质类固醇、胰高血糖素样肽1(GLP-1)为主的内分泌信号,以及感染与菌群失调、炎症与免疫激活等为主的免疫信号调控异常与IBS的相关性做一探讨。

Irritable bowel syndrome(IBS)is one of the most common functional gastrointestinal disorders(FGIDs)clinically,and its pathophysiological changes have not been fully explained.Underlying mechanisms that could lead to IBS include genetic factors,post-infectious changes,chronic infections and disturbances in the intestinal microbiota,lowgrade mucosal inflammation,immune activation,and altered intestinal permeability,disordered bile salt metabolism,and abnormalities in serotonin metabolism.RomeⅣhas emphasized the significance of correlation between the occurrence of IBS and abnormalities of neuro-gastroenterology and brain-gut interactions,with complex neuro-endocrine-immune(NEI)factors involved,featuring the heterogeneity of IBS clinical manifestations.Based on domestic and overseas research achievement,this article explores the relevance between the altered NEI signals and pathogenesis of IBS,which includes neural factors mainly focusing on autonomic nervous dysfunction and visceral hypersensitivity in brain-gut and gut-brain interactions,endocrine factors of corticotropin-releasing factor(CRF),corticosteroids and glucagon-like peptide 1(GLP-1),and immune factors of infections and dysbacteriosis,inflammation and immune activation.