目的:对中医药治疗肠易激综合征(irritable bowel syndrome,IBS)的系统评价/Meta分析进行再评价研究.方法:计算机检索Cochrane Library、PubMed、AMED、E M b a s e、C B M、C N K I、V I P和WanFang Data,收集中医药治疗IBS的系统评价/...目的:对中医药治疗肠易激综合征(irritable bowel syndrome,IBS)的系统评价/Meta分析进行再评价研究.方法:计算机检索Cochrane Library、PubMed、AMED、E M b a s e、C B M、C N K I、V I P和WanFang Data,收集中医药治疗IBS的系统评价/Meta分析文章,检索时限均从建库至2013-11.由2位研究者按照纳入标准独立筛选文献、提取资料后,采用AMSTAR评价纳入研究质量,同时采用GRADE系统对主要研究结果进行证据质量分级.结果:共纳入14个相关系统评价/Meta分析,10篇研究评价了中草药疗效,4篇研究评价了针灸疗法,AMSTAR评分在2-10分之间,再评价主要结果显示,中医药治疗IBS较常规西药具有一定优势,但证据质量等级普遍较低.结论:本研究为中医药临床治疗IBS提供一定参考,但基于GRADE证据质量等级,建议证据使用者根据临床实践的具体情况进行循证决策.此外,中医药临床研究需根据自身特点,选择合适的研究设计方法,进一步开展高质量的临床研究,为评价中医药治疗IBS的临床疗效提供高质量的证据.展开更多
目的:通过文献分析临床针灸治疗腹泻型(D-IBS)和便秘型肠易激惹综合征(C-IBS)的经脉、腧穴选择特点和规律。方法:检索中国知网、万方、维普、Pubmed、Web of Science等数据库,收集2000—2016年针灸治疗D-IBS和C-IBS的临床研究报道,提取...目的:通过文献分析临床针灸治疗腹泻型(D-IBS)和便秘型肠易激惹综合征(C-IBS)的经脉、腧穴选择特点和规律。方法:检索中国知网、万方、维普、Pubmed、Web of Science等数据库,收集2000—2016年针灸治疗D-IBS和C-IBS的临床研究报道,提取其所使用的针灸方式、经脉和腧穴。运用描述性分析、关联性分析和聚类分析研究其内在联系与规律规律,同时观察针灸治疗D-IBS和C-IBS的经脉、腧穴各自的规律和它们之间的差异。结果:共纳入针灸治疗D-IBS文献56篇、针灸治疗C-IBS文献6篇,D-IBS的治疗主要用针刺,临床以胃经和任脉的腧穴为主,如天枢、足三里、中脘,关联性分析发现胃经—任脉—脾经的为最常见的经脉组合,腧穴以足三里—天枢—太冲为主要关联群。聚类分析经脉主要分成2个核心聚类群,2个核心群组,腧穴则可以分成5个聚类群,5个核心群组。而C-IBS的研究则主要以悬灸为主,胃经、膀胱经的腧穴应用最多,如天枢、足三里、大肠俞、上巨虚,关联性分析发现经脉组合与D-IBS相同,也是胃经—任脉—脾经组合支持度和置信度最高,而腧穴则是以足三里—天枢的配伍最为常见。聚类分析则发现经脉、腧穴均可以分成2个核心聚类群,2个核心群组。结论:通过分析针灸治疗D-IBS和C-IBS的临床研究,认为虽然两者在针灸方法的使用上略微存在差异,D-IBS针灸并用,C-IBS以灸为主。但是在经脉和腧穴选择上却存在高度相似性。展开更多
目的:从结肠、海马及下丘脑中促肾上腺皮质激素释放因子(corticotropin releasing factor,CRF)和CRF受体1(CRF receptor 1,CRFR1)角度探讨健脾化湿颗粒改善腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,D-IBS)模...目的:从结肠、海马及下丘脑中促肾上腺皮质激素释放因子(corticotropin releasing factor,CRF)和CRF受体1(CRF receptor 1,CRFR1)角度探讨健脾化湿颗粒改善腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,D-IBS)模型大鼠结肠运动和内脏敏感性的作用机制.方法:采用番泻叶灌胃结合束缚应激法建立D-I B S大鼠模型,应用健脾化湿颗粒进行干预,采用酶联免疫法(ELISA)检测大鼠结肠中CRF含量,采用免疫组织化学法检测结肠中CRFR1及海马、下丘脑中CRF,CRFR1阳性表达,采用RT-PCR法检测结肠、海马中CRF m RNA和CRFR1 m RNA的表达水平.结果:与正常组相比,模型组结肠中CRF含量(67.1±3.8 vs 36.0±3.0),海马、下丘脑中CRF阳性表达(0.23±0.02 vs 0.09±0.01,0.17±0.02 v s 0.09±0.01)明显升高(P<0.01);结肠、海马、下丘脑中C R F R1阳性表达(0.17±0.01 vs 0.03±0.01,0.20±0.02 vs 0.09±0.01,0.19±0.02 vs 0.07±0.01)明显升高(P<0.01);结肠、海马中C R F m RNA和CRFR1 m RNA的表达(结肠:0.89±0.04 vs 0.09±0.01,1.09±0.09 vs 0.21±0.04;海马:0.56±0.01 vs 0.15±0.05,1.26±0.14 vs 0.23±0.06)显著升高(P<0.01).与模型组相比,各治疗组结肠、海马中C R F(51.0±3.4,54.6±4.1,45.1±4.7,43.3±3.9 vs 67.1±3.8;0.18±0.02,0.19±0.02,0.15±0.02,0.11±0.01 vs 0.23±0.02)显著下降(P<0.01),阳性对照组、中、高剂量组下丘脑中CRF(0.15±0.02,0.13±0.01,0.12±0.01 vs 0.17±0.02)下降显著(P<0.05,P<0.0 1);阳性对照组、中、高剂量组结肠、海马、下丘脑中C R F R1表达(结肠:0.10±0.01,0.08±0.01,0.05±0.01 vs 0.17±0.01;海马:0.16±0.01,0.14±0.02,0.13±0.01 vs 0.20±0.02;下丘脑:0.15±0.02,0.13±0.01,0.11±0.01 vs 0.19±0.02)下降显著(P<0.05,P<0.01);结肠中CRF m RNA表达(0.63±0.04,0.76±0.06,0.32±0.06,0.13±0.03 v s 0.89±0.04)及中、高剂量组海马中CRF m RNA表达(0.76±0.11,0.67±0.10 v s 1.09±0.09)显著降低(P<0.01);阳性对照组、中、高剂量组结肠中C R F R1m RNA表达(0.47±0.03,0.40±0.06,0.24±0.06 vs 0.56±0.01)及中、高剂量组海马中CRFR1 m RNA表达(0.62±0.06,0.60±0.07vs 1.26±0.14)显著降低(P<0.05,P<0.01).结论:健脾化湿颗粒可能通过下调结肠、海马及下丘脑中CRF、CRFR1表达来改善D-IBS模型大鼠结肠运动和内脏敏感性.展开更多
Electroacupuncture at Shangjuxu （ST37） and Tianshu （ST25） can improve visceral hypersensitivity in rats. Colorectal distension was used to establish a rat model of chronic visceral hypersensitivity. Immunohistoche...Electroacupuncture at Shangjuxu （ST37） and Tianshu （ST25） can improve visceral hypersensitivity in rats. Colorectal distension was used to establish a rat model of chronic visceral hypersensitivity. Immunohistochemistry was used to detect P2X2 and P2X3 receptor expression in dorsal root ganglia from rats with chronic visceral hypersensitivity. Results demonstrated that abdominal withdrawal reflex scores obviously increased following establishment of the model, indicating visceral hypersensitivity. Simultaneously, P2X2 and P2X3 receptor expression increased in dorsal root ganglia. After bilateral electroacupuncture at Shangjuxu and Tianshu, abdominal withdrawal reflex scores and P2X2 and P2X3 receptor expression decreased in rats with visceral hypersensitivity. These results indicated that electroacupuncture treatment improved visceral hypersensitivity in rats with irritable bowel syndrome by reducing P2X2 and P2X3 receptor expression in dorsal root ganglia.展开更多
AIM: To validate 4-sample lactose hydrogen breath testing(4SLHBT) compared to standard 13-sample LHBT in the clinical setting.METHODS: Irritable bowel syndrome patients with diarrhea(IBS-D) and healthy volunteers(HVs)...AIM: To validate 4-sample lactose hydrogen breath testing(4SLHBT) compared to standard 13-sample LHBT in the clinical setting.METHODS: Irritable bowel syndrome patients with diarrhea(IBS-D) and healthy volunteers(HVs) were enrolled and received a 10 g, 20 g, or 40 g doselactose hydrogen breath test(LHBT) in a randomized, double-blinded, controlled trial. The lactase gene promoter region was sequenced. Breath samples and symptoms were acquired at baseline and every 15 min for 3 h(13 measurements). The detection rates of lactose malabsorption(LM) and lactose intolerance(LI) for a 4SLHBT that acquired four measurements at 0, 90, 120, and 180 min from the same data set were compared with the results of standard LHBT.RESULTS: Sixty IBS-D patients and 60 HVs were studied. The genotype in all participants was C/C-13910. LM and LI detection rates increased with lactose dose from 10 g, 20 g to 40 g in both groups(P < 0.001). 4SLHBT showed excellent diagnostic concordance with standard LHBT(97%-100%, Kappa 0.815-0.942) with high sensitivity(90%-100%) and specificity(100%) at all three lactose doses in both groups.CONCLUSION: Reducing the number of measurements from 13 to 4 samples did not significantly impact on the accuracy of LHBT in health and IBS-D. 4SLHBT is a valid test for assessment of LM and LI in clinical practice.展开更多
From a pure motor disorder of the bowel,in the past few years,irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity,alterations at the level of nervous and humoral c...From a pure motor disorder of the bowel,in the past few years,irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity,alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system,alteration of the gut microflora,an increased intestinal permeability and minimum intestinal inflammation.Psychological and social factors can interfere with the communication between the central and enteric nervous systems,and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome.There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders.In order to explain clustering of IBS in families,genetic factors and social learning mechanisms have been proposed.The psychological features,such as anxiety,depression as well as the comorbid psychiatric disorders,health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.展开更多
AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use ...AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO. METHODS: A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.. RESULTS: When the patients underwent a "breath test", 33 (45.2%) showed the presence of a SIBO. After treatment with rifaximin 1200 mg/d for seven days in 32 patients, 19 (59.4%) showed a negative "breath test" one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, "breath test" remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative "breath test" in one patient only. CONCLUSION: (1) about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; (2) only a "breath test" with lactulose (or with glucose in subjects with an intolerance to lactose) can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and (3) the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.展开更多
文摘目的:对中医药治疗肠易激综合征(irritable bowel syndrome,IBS)的系统评价/Meta分析进行再评价研究.方法:计算机检索Cochrane Library、PubMed、AMED、E M b a s e、C B M、C N K I、V I P和WanFang Data,收集中医药治疗IBS的系统评价/Meta分析文章,检索时限均从建库至2013-11.由2位研究者按照纳入标准独立筛选文献、提取资料后,采用AMSTAR评价纳入研究质量,同时采用GRADE系统对主要研究结果进行证据质量分级.结果:共纳入14个相关系统评价/Meta分析,10篇研究评价了中草药疗效,4篇研究评价了针灸疗法,AMSTAR评分在2-10分之间,再评价主要结果显示,中医药治疗IBS较常规西药具有一定优势,但证据质量等级普遍较低.结论:本研究为中医药临床治疗IBS提供一定参考,但基于GRADE证据质量等级,建议证据使用者根据临床实践的具体情况进行循证决策.此外,中医药临床研究需根据自身特点,选择合适的研究设计方法,进一步开展高质量的临床研究,为评价中医药治疗IBS的临床疗效提供高质量的证据.
文摘目的:通过文献分析临床针灸治疗腹泻型(D-IBS)和便秘型肠易激惹综合征(C-IBS)的经脉、腧穴选择特点和规律。方法:检索中国知网、万方、维普、Pubmed、Web of Science等数据库,收集2000—2016年针灸治疗D-IBS和C-IBS的临床研究报道,提取其所使用的针灸方式、经脉和腧穴。运用描述性分析、关联性分析和聚类分析研究其内在联系与规律规律,同时观察针灸治疗D-IBS和C-IBS的经脉、腧穴各自的规律和它们之间的差异。结果:共纳入针灸治疗D-IBS文献56篇、针灸治疗C-IBS文献6篇,D-IBS的治疗主要用针刺,临床以胃经和任脉的腧穴为主,如天枢、足三里、中脘,关联性分析发现胃经—任脉—脾经的为最常见的经脉组合,腧穴以足三里—天枢—太冲为主要关联群。聚类分析经脉主要分成2个核心聚类群,2个核心群组,腧穴则可以分成5个聚类群,5个核心群组。而C-IBS的研究则主要以悬灸为主,胃经、膀胱经的腧穴应用最多,如天枢、足三里、大肠俞、上巨虚,关联性分析发现经脉组合与D-IBS相同,也是胃经—任脉—脾经组合支持度和置信度最高,而腧穴则是以足三里—天枢的配伍最为常见。聚类分析则发现经脉、腧穴均可以分成2个核心聚类群,2个核心群组。结论:通过分析针灸治疗D-IBS和C-IBS的临床研究,认为虽然两者在针灸方法的使用上略微存在差异,D-IBS针灸并用,C-IBS以灸为主。但是在经脉和腧穴选择上却存在高度相似性。
文摘目的:从结肠、海马及下丘脑中促肾上腺皮质激素释放因子(corticotropin releasing factor,CRF)和CRF受体1(CRF receptor 1,CRFR1)角度探讨健脾化湿颗粒改善腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,D-IBS)模型大鼠结肠运动和内脏敏感性的作用机制.方法:采用番泻叶灌胃结合束缚应激法建立D-I B S大鼠模型,应用健脾化湿颗粒进行干预,采用酶联免疫法(ELISA)检测大鼠结肠中CRF含量,采用免疫组织化学法检测结肠中CRFR1及海马、下丘脑中CRF,CRFR1阳性表达,采用RT-PCR法检测结肠、海马中CRF m RNA和CRFR1 m RNA的表达水平.结果:与正常组相比,模型组结肠中CRF含量(67.1±3.8 vs 36.0±3.0),海马、下丘脑中CRF阳性表达(0.23±0.02 vs 0.09±0.01,0.17±0.02 v s 0.09±0.01)明显升高(P<0.01);结肠、海马、下丘脑中C R F R1阳性表达(0.17±0.01 vs 0.03±0.01,0.20±0.02 vs 0.09±0.01,0.19±0.02 vs 0.07±0.01)明显升高(P<0.01);结肠、海马中C R F m RNA和CRFR1 m RNA的表达(结肠:0.89±0.04 vs 0.09±0.01,1.09±0.09 vs 0.21±0.04;海马:0.56±0.01 vs 0.15±0.05,1.26±0.14 vs 0.23±0.06)显著升高(P<0.01).与模型组相比,各治疗组结肠、海马中C R F(51.0±3.4,54.6±4.1,45.1±4.7,43.3±3.9 vs 67.1±3.8;0.18±0.02,0.19±0.02,0.15±0.02,0.11±0.01 vs 0.23±0.02)显著下降(P<0.01),阳性对照组、中、高剂量组下丘脑中CRF(0.15±0.02,0.13±0.01,0.12±0.01 vs 0.17±0.02)下降显著(P<0.05,P<0.0 1);阳性对照组、中、高剂量组结肠、海马、下丘脑中C R F R1表达(结肠:0.10±0.01,0.08±0.01,0.05±0.01 vs 0.17±0.01;海马:0.16±0.01,0.14±0.02,0.13±0.01 vs 0.20±0.02;下丘脑:0.15±0.02,0.13±0.01,0.11±0.01 vs 0.19±0.02)下降显著(P<0.05,P<0.01);结肠中CRF m RNA表达(0.63±0.04,0.76±0.06,0.32±0.06,0.13±0.03 v s 0.89±0.04)及中、高剂量组海马中CRF m RNA表达(0.76±0.11,0.67±0.10 v s 1.09±0.09)显著降低(P<0.01);阳性对照组、中、高剂量组结肠中C R F R1m RNA表达(0.47±0.03,0.40±0.06,0.24±0.06 vs 0.56±0.01)及中、高剂量组海马中CRFR1 m RNA表达(0.62±0.06,0.60±0.07vs 1.26±0.14)显著降低(P<0.05,P<0.01).结论:健脾化湿颗粒可能通过下调结肠、海马及下丘脑中CRF、CRFR1表达来改善D-IBS模型大鼠结肠运动和内脏敏感性.
基金funded by the National Natural Science Foundation of China,No.30973783the Shanghai Municipal Scientific Committee Project,No.11ZR1434300the Key Subject Program of State Administration of Traditional Chinese Medicine
文摘Electroacupuncture at Shangjuxu （ST37） and Tianshu （ST25） can improve visceral hypersensitivity in rats. Colorectal distension was used to establish a rat model of chronic visceral hypersensitivity. Immunohistochemistry was used to detect P2X2 and P2X3 receptor expression in dorsal root ganglia from rats with chronic visceral hypersensitivity. Results demonstrated that abdominal withdrawal reflex scores obviously increased following establishment of the model, indicating visceral hypersensitivity. Simultaneously, P2X2 and P2X3 receptor expression increased in dorsal root ganglia. After bilateral electroacupuncture at Shangjuxu and Tianshu, abdominal withdrawal reflex scores and P2X2 and P2X3 receptor expression decreased in rats with visceral hypersensitivity. These results indicated that electroacupuncture treatment improved visceral hypersensitivity in rats with irritable bowel syndrome by reducing P2X2 and P2X3 receptor expression in dorsal root ganglia.
基金Supported by Nestle Research International and The Science and Technology Department of Zhejiang Province,No.2009C14016
文摘AIM: To validate 4-sample lactose hydrogen breath testing(4SLHBT) compared to standard 13-sample LHBT in the clinical setting.METHODS: Irritable bowel syndrome patients with diarrhea(IBS-D) and healthy volunteers(HVs) were enrolled and received a 10 g, 20 g, or 40 g doselactose hydrogen breath test(LHBT) in a randomized, double-blinded, controlled trial. The lactase gene promoter region was sequenced. Breath samples and symptoms were acquired at baseline and every 15 min for 3 h(13 measurements). The detection rates of lactose malabsorption(LM) and lactose intolerance(LI) for a 4SLHBT that acquired four measurements at 0, 90, 120, and 180 min from the same data set were compared with the results of standard LHBT.RESULTS: Sixty IBS-D patients and 60 HVs were studied. The genotype in all participants was C/C-13910. LM and LI detection rates increased with lactose dose from 10 g, 20 g to 40 g in both groups(P < 0.001). 4SLHBT showed excellent diagnostic concordance with standard LHBT(97%-100%, Kappa 0.815-0.942) with high sensitivity(90%-100%) and specificity(100%) at all three lactose doses in both groups.CONCLUSION: Reducing the number of measurements from 13 to 4 samples did not significantly impact on the accuracy of LHBT in health and IBS-D. 4SLHBT is a valid test for assessment of LM and LI in clinical practice.
基金Supported by The Sectorial Operational Programme Human Resources Development,Contract POSDRU 6/1.5/S/3-,Doctoral studies: through science towards society
文摘From a pure motor disorder of the bowel,in the past few years,irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity,alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system,alteration of the gut microflora,an increased intestinal permeability and minimum intestinal inflammation.Psychological and social factors can interfere with the communication between the central and enteric nervous systems,and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome.There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders.In order to explain clustering of IBS in families,genetic factors and social learning mechanisms have been proposed.The psychological features,such as anxiety,depression as well as the comorbid psychiatric disorders,health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.
文摘AIM: To estimate the prevalence of small intestine bacterial overgrowth (SIBO) among patients with an earlier diagnosis of irritable bowel disease (IBS) in our geographical area, and to collect information on the use of locally acting non-absorbable antibiotics in the management of SIBO. METHODS: A non-interventional study was conducted in 73 consecutive patients with a symptom-based diagnosis.. RESULTS: When the patients underwent a "breath test", 33 (45.2%) showed the presence of a SIBO. After treatment with rifaximin 1200 mg/d for seven days in 32 patients, 19 (59.4%) showed a negative "breath test" one week later as well as a significant reduction of symptoms, thus confirming the relationship between SIBO and many of the symptoms claimed by patients. In the other 13 patients, "breath test" remained positive, and a further cycle of treatment with ciprofloxacin 500 mg/d was given for 7 additional days, resulting in a negative "breath test" in one patient only. CONCLUSION: (1) about half of the patients with a symptomatic diagnosis of IBS have actually SIBO, which is responsible for most of the symptoms attributed to IBS; (2) only a "breath test" with lactulose (or with glucose in subjects with an intolerance to lactose) can provide a differential diagnosis between IBS and SIBO, with almost identical symptoms; and (3) the use of non-absorbable antibiotics may be useful to reduce the degree of SIBO and related symptoms; it must be accompanied, however, by the correction of the wrong alimentary habits underlying SIBO.
