腹泻型肠易激综合征患者炎症因子水平变化及与中医证型的关系

Changes of Serum Inflammatory Factors in Patients with Irritable Bowel Syndrome with Diarrhea and the Relationship with Traditional Chinese Medicine Syndrome Types

目的 分析腹泻型肠易激综合征(IBS with diarrhea,IBS-D)患者血清炎症因子白细胞介素(Interleukin,IL-4)(Interleukin,IL-6)(Interleukin,IL-8)(Interleukin,IL-10)、肿瘤坏死因子α(Tumor necrosis factor-α,TNF-α)和γ-干扰素(Interferon-γ,IFN-γ)水平的变化并探究IBS-D中医证型与血清炎症因子的关系。方法 纳入IBS-D患者42例,健康志愿者20例,根据诊断标准IBS-D组中肝气乘脾证9例,脾胃虚弱证8例,脾肾阳虚证5例,大肠湿热证20例,进一步可分为非湿热证22例,湿热证20例,共同进行临床资料的收集和血清样本的采集,酶联免疫吸附法(Enzyme-Linked immunosorbent assay,ELISA)检测血清炎症因子水平。结果 IBS-D组血清中IL-4水平低于健康对照组,TNF-α水平高于健康对照组,差异有统计学意义(P<0.05);IBS-D组血清中IL-6、IL-8、IL-10、IFN-γ与健康对照组比较,差异无统计学意义(P>0.05)。不同证型血清IL-8水平存在显著差异(P<0.01),肝气乘脾证患者血清IL-8水平较脾胃虚弱证患者显著增高(P<0.01),大肠湿热证患者血清IL-8水平较脾胃虚弱证患者显著增高(P<0.01)。湿热证、非湿热证、HC组间血清IL-8水平存在显著差异(P<0.05),湿热证患者血清IL-8水平较非湿热证患者增高(P<0.05)。湿热证患者血清TNF-α、IFN-γ水平较非湿热证患者有升高趋势,IL-10水平较非湿热证患者有降低趋势,但无显著统计学差异,湿热证患者血清TNF-α水平较HC组显著增高(P<0.05)。结论 IBS-D患者的低度炎症状态可能与血清中抑炎因子水平降低和促炎因子水平升高有关;IBS-D不同中医证型血清炎症因子水平存在差异,湿热可能与IBS-D低度炎症状态和免疫激活有关。

Objective To analyze the changes of serum inflammatory factors Interleukin-4(IL-4),IL-6,IL-8,IL-10,tumor necrosis factor-alpha(TNF-α)and interferon-gamma(IFN-γ)levels in patients with irritable bowel syndrome with diarrhea(IBS-D),and to explore the relationship between traditional Chinese medicine(TCM)syndrome types of IBS-D and serum inflammatory factors.Methods A total of 42 IBS-D patients and 30 healthy volunteers were included in this study.According to the diagnostic criteria,in IBS-D group,there were 9 cases of stagnation of liver qi and spleen deficiency,8 cases of weakness of the spleen and the stomach,5 cases of spleen-kidney yang deficiency syndrome,and 20 cases of large intestine damp-heat syndrome.They can be further divided into 22 cases of non-damp-heat syndrome,and 20 cases of damp-heat syndrome.Clinical data and serum samples from the patients and healthy volunteers were collected,and serum inflammatory factor levels were detected by enzyme-linked immunosorbent assay(ELISA).Results The serum level of IL-4 in IBS-D group was lower than that in healthy control group(P<0.05)and the level of TNF-α in IBS-D group was higher than that in healthy control group(P<0.05).There was no significant difference in serum IL-6,IL-8,IL-10 and IFN-γ levels between the two groups(P>0.05).There were significant differences in serum IL-8 levels among different syndrome types(P<0.01).The level of serum IL-8 in patients with stagnation of liver qi and spleen deficiency was significantly higher than that in patients with weakness of the spleen and the stomach(P<0.01).The level of serum IL-8 in patients with large intestine damp-heat syndrome was significantly higher than that in patients with weakness of the spleen and the stomach(P<0.01).There were significant differences in serum IL-8 levels among damp-heat syndrome,non-damp-heat syndrome and healthy control groups(P<0.05).The level of serum IL-8 in patients with damp-heat syndrome was higher than that in patients without damp-heat syndrome(P<0.05).The serum levels of TNF-α and IFN-γ in patients with damp-heat syndrome were higher than those in patients without damp-heat syndrome and the level of serum IL-10 in patients with damp-heat syndrome was lower than that in patients without damp-heat syndrome,but there were no significant difference.The level of serum TNF-α in patients with damp-heat syndrome was significantly higher than that in the healthy control group(P<0.05).Conclusion The low-grade inflammation of IBS-D patients may be related to the decreased level of anti-inflammatory factors and increased level of pro-inflammatory factors in the serum.There are differences in serum levels of inflammatory factors among different TCM Syndrome types of IBS-D,and damp-heat syndrome may be related to the low-grade inflammatory state and immune activation of IBS-D.