高原IBS与肠屏障损伤、炎性介质及神经递质的相关性研究

doi:10.11958/20230882

天津医药 ›› 2024, Vol. 52 ›› Issue (5): 499-504.doi: 10.11958/20230882

高原IBS与肠屏障损伤、炎性介质及神经递质的相关性研究

张兴光¹(), 王邦茂², 刘涛涛¹, 张文成¹, 董艳美¹, 李小青¹, 牛海艳¹, 夏时海¹^,^△()

1 武警特色医学中心消化内科（邮编300162）
2 天津医科大学总医院消化内科

收稿日期:2023-06-13 修回日期:2023-09-12 出版日期:2024-05-15 发布日期:2024-05-09
通讯作者: ^△ E-mail：xshhcx@sina.com
作者简介:张兴光（1984），男，主治医师，主要从事内镜下消化道早癌及高原肠道菌群方面研究。E-mail：zhangxingguang1024@163.com

Correlation study between high altitude IBS and intestinal barrier damage, inflammatory mediators and neurotransmitters

ZHANG Xingguang¹(), WANG Bangmao², LIU Taotao¹, ZHANG Wencheng¹, DONG Yanmei¹, LI Xiaoqing¹, NIU Haiyan¹, XIA Shihai¹^,^△()

1 Department of Gastroenterology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin 300162, China
2 Department of Gastroenterology, Tianjin Medical University General Hospital

Received:2023-06-13 Revised:2023-09-12 Published:2024-05-15 Online:2024-05-09
Contact: ^△ E-mail：xshhcx@sina.com

张兴光, 王邦茂, 刘涛涛, 张文成, 董艳美, 李小青, 牛海艳, 夏时海. 高原IBS与肠屏障损伤、炎性介质及神经递质的相关性研究[J]. 天津医药, 2024, 52(5): 499-504.

ZHANG Xingguang, WANG Bangmao, LIU Taotao, ZHANG Wencheng, DONG Yanmei, LI Xiaoqing, NIU Haiyan, XIA Shihai. Correlation study between high altitude IBS and intestinal barrier damage, inflammatory mediators and neurotransmitters[J]. Tianjin Medical Journal, 2024, 52(5): 499-504.

摘要/Abstract

摘要：

目的分析高原环境下肠易激综合征（IBS）患者的肠屏障损伤指标、神经递质及炎性介质变化，探讨IBS的潜在发病机制。方法 81例男性汉族健康志愿者自平原进入西藏拉萨并完成1年前瞻性队列观察，其中诊断IBS（罗马Ⅳ）13例（IBS组），并随机抽取11例健康者为对照组（NC组），另随机抽取从平原进入拉萨1周内且未发生急性高山病者11例为NC早期组。采用酶联免疫吸附试验（ELISA）检测血清二胺氧化酶（DAO）和肠脂肪酸结合蛋白（I-FABP）、5羟色胺（5-HT）、白细胞介素（IL）-6、IL-17A及脂多糖（LPS）水平；随访末月，IBS中9例行肠镜检查及肠黏膜病理活检，NC组中4例行肠镜检查。结果高原环境下IBS患者肠镜及病理结果提示肠黏膜轻度炎症表现。与NC早期组比较，NC组进入拉萨后3个月时5-HT、DAO、I-FABP、IL-6、IL-17A和LPS水平及6个月时5-HT、I-FABP、IL-6和LPS水平均升高，IBS组3、6个月时6项血清学指标均升高（P<0.05）；与NC组比较，IBS组3个月时5-HT和LPS水平降低，6个月时DAO、I-FABP、IL-6、IL-17A和LPS水平升高（P<0.05）。NC组6个月时6项血清学指标均较3个月时降低（P<0.05）；IBS组3个月与6个月时血清学指标差异均无统计学意义。结论肠黏膜屏障损伤指标、神经递质及炎性介质可能参与高原环境下IBS的发生。

关键词: 肠易激综合征, 血清素, 脂肪酸结合蛋白质类, 白细胞介素6, 高原环境

Abstract:

Objective To analyzing changes of indicators related to intestinal barrier damage, neurotransmitters and inflammatory mediators in patients with irritable bowel syndrome (IBS) in the plateau environment, and explore the underlying pathogenesis of IBS. Methods A prospective cohort observation was conducted on 81 healthy male Han Chinese volunteers who were admitted to Lhasa of Tibe from plain. The study lasted for one year. During the one-year follow-up, 13 patients who developed IBS (Rome Ⅳ) were selected as the study subjects. Additionally 11 participants who remained healthy were randomly selected as the control group (named NC). Eleven participants who entered Lhasa from plain within one week and did not develop acute mountain sickness were randomly selected as the NC early group. Serum levels of diamine oxidase (DAO) and intestinal fatty acid-binding protein (I-FABP), 5-hydroxytryptamine (5-HT), interleukin (IL)-6, IL-17A and lipopolysaccharide (LPS) were measured using enzyme-linked immunosorbent assay (ELISA). At the end of the follow-up period, colonoscopy and intestinal mucosal biopsy were performed in 9 cases of IBS, while colonoscopy was performed in 4 cases of NC. Results Colonoscopy and pathological results of IBS patients in plateau environment suggested mild inflammation of intestinal mucosa. Compared to the NC early group, the NC group showed increased levels of 5-HT, DAO, I-FABP, IL-6, IL-17A and LPS at 3 months after entering Lassa, and increased levels of 5-HT, I-FABP, IL-6, and LPS at 6 months (P<0.05). Compared with the NC group, the IBS group showed decreased levels of 5-HT and LPS at 3 months after entering Lhasa (P<0.05). Serological indexes of NC group at 6 months were lower than those at 3 months in the NC group (P<0.05). There were no significant differences in serological indexes at 3 and 6 months of the IBS group. Conclusion Indicators of intestinal mucosal barrier damage, neurotransmitters and inflammatory mediators might be involved in the development of IBS in plateau environment.

Key words: irritable bowel syndrome, serotonin, fatty acid-binding proteins, interleukin 6, plateau environment

中图分类号:

R574.4

图/表 4

表1 各组人群基线特征比较

Tab.1 Comparison of baseline characteristics between three groups

组别	n	年龄/岁	BMI/（kg/m²）	学历（大专以下/大专及以上）	睡眠/h
NC早期组	11	19.73±1.27	23.33±3.11	3/8	8.64±0.55
NC组	11	20.09±1.22	22.19±2.33	4/7	8.00±0.71^a
IBS组	13	20.23±1.48	21.44±1.32	6/7	8.15±0.55^a
F或χ²		0.438	1.995	0.923	3.337^＊

图1 末次随访时IBS组与NC组肠镜下黏膜表现 IBS病例A，肠镜下表现为结肠黏膜散在几处斑点状充血；IBS病例B，肠镜下表现为结肠及直肠均可见广泛的黏膜轻度充血水肿；NC组受检者C、D，肠镜下黏膜形态表现基本正常，似有极轻微的水肿。

Fig.1 Colonoscopic mucosal manifestations between the IBS group and the NC group at the last follow-up

图2 HE染色观察IBS患者肠黏膜病理表现（×100）

Fig.2 HE staining of intestinal mucosa in patients with IBS (×100)

表2 高原环境下各组不同时点血清学指标的比较

Tab.2 Comparison of serological parameters at different time points in plateau environment between three groups

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高原IBS与肠屏障损伤、炎性介质及神经递质的相关性研究

Correlation study between high altitude IBS and intestinal barrier damage, inflammatory mediators and neurotransmitters

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