腹泻型肠易激综合征中医证型与血清Endocan的相关性研究

Correlation between traditional Chinese medicine syndrome type and serum Endocan in diarrheal irritable bowel syndrome

目的探讨腹泻型肠易激综合征(IBS-D)患者的中医辨证分型特点及其与血清内皮细胞特异性分子-1(Endocan)水平的相关性。方法选取2022年3月—2023年4月在北京中医药大学第三附属医院脾胃病科门诊就诊的127例IBS-D患者作为IBS-D组,另以同期27例健康体检者作为健康组,收集受检者的年龄、性别、中医四诊辨证资料及实验室检查、影像学检查结果,统计IBS-D患者中医证型分布情况,比较不同中医证型IBS-D患者的血清Endocan水平,Pearson相关性分析中医证型与血清Endocan水平的相关性。结果127例IBS-D患者中,以大肠湿热证[29.9%(38/127)]、肝郁脾虚证[28.3%(36/127)]多见,其次为寒热错杂、脾虚湿盛证和脾肾阳虚证。IBS-D组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、Endocan水平均明显高于健康组(P均<0.05)。IBS-D不同证型间血清Endocan水平比较差异有统计学意义(P<0.05),血清Endocan水平由高到低依次为大肠湿热证(6.31±0.48)ng/mL、肝郁脾虚证(5.04±0.57)ng/mL、脾虚湿盛证(3.11±0.42)ng/mL、寒热错杂证(2.96±0.38)ng/mL、脾肾阳虚证(2.92±0.35)ng/mL,其中大肠湿热证患者血清Endocan水平均明显高于其他证型患者(P均<0.05),肝郁脾虚证患者血清Endocan水平均明显高于寒热错杂证、脾肾阳虚证和脾虚湿盛证患者(P均<0.05),寒热错杂证、脾肾阳虚证和脾虚湿盛证患者间血清Endocan水平比较差异均无统计学意义(P均>0.05)。Pearson相关性分析显示,大肠湿热证、肝郁脾虚证与血清Endocan水平均呈正相关(P均<0.05)。结论IBS-D患者机体存在轻度炎症反应,血清Endocan水平可作为IBS-D的中医辨证分型参考指标。

Objective It is to investigate the characteristics of syndrome differentiation and classification of irritable bowel syndrome with diarrhea(IBS-D)in traditional Chinese medicine(TCM),and to analyze its correlation with serum Endocan.Methods A total of 127 IBS-D patients treated in outpatient clinic of the Department of Splenology and Gastroenterology of the Third Affiliated Hospital of Beijing University of Chinese Medicine from March 2022 to April 2023 were selected as IBS-D group,27 healthy physical examination subjects were selected as the control group.The age,gender,four diagnostic data of Chinese medicine and the results of laboratory examination and imaging examination of the subjects were collected,the distribution of TCM syndrome of IBS-D patients was counted,the serum level of Endocan of IBS-D patients with different TCM syndrome were compared,and the correlation between TCM syndrome and serum level of Endocan was analyzed by Pearson correlation analysis.Results In 127 cases of IBS-D patients,large intestine dampness-heat syndrome[29.9%(38/127)],liver depression and spleen deficiency syndrome[28.3%(36/127)]were more common,followed by cold-heat complex syndrome,spleen deficiency with dampness exuberance syndrome and spleen-kidney Yang deficiency syndrome.The serum levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),and Endocan of the IBS-D group were significantly higher than those of the healthy group(all P<0.05).The differences in the serum level of Endocan among different syndrome types of IBS-D were statistically significant(all P<0.05),and the serum levels of Endocan from high to low were as follows:large intestine dampness-heat syndrome(6.31±0.48)ng/mL,liver depression and spleen deficiency syndrome(5.04±0.57)ng/mL,spleen deficiency with dampness exuberance syndrome(3.11±0.42)ng/mL,cold-heat complex syndrome(2.96±0.38)ng/mL,and spleen-kidney Yang deficiency syndrome(2.92±0.35)ng/mL.The serum level of Endocan in patients with large intestine dampness-heat syndrome was significantly higher that that of patients with other syndromes(all P<0.05),and the level in patients with liver depression and spleen deficiency syndrome was higher than that in patients with cold-heat complex syndrome,spleen-kidney Yang deficiency syndrome and spleen deficiency with dampness exuberance syndrome(all P<0.05),there was no statistical significance among the patients with cold-heat complex syndrome,spleen-kidney Yang deficiency syndrome and spleen deficiency with dampness exuberance syndrome(all P>0.05).Pearson correlation analysis showed that large intestine dampness-heat syndrome and liver depression and spleen deficiency syndrome were positive related with serum Endocan(both P<0.05).Conclusion There is a mild inflammatory response in IBS-D patients,and the serum level of Endocan can be used as a reference index for TCM differentiation and classification of IBS-D.