CAJ | 학술논문

目的比较肠易激综合征(IBS)伴精神障碍与不伴精神障碍患者的肠道黏膜炎症指标,了解炎症与IBS精神障碍共病的关系.方法顺序纳入2008年11月至2011年3月在北京大学第三医院消化科门诊就诊、符合罗马Ⅲ标准的IBS患者43例及无消化道症状的志愿者(对照组)15名,由经过培训的人员应用复合性国际诊断交谈表(CIDI)对其进行访谈；所有纳入者行结肠镜检查并取回肠末端和结肠黏膜活检组织,比较IBS不伴精神障碍(24例)及伴精神障碍(19例)患者与对照组(13名,有精神障碍者2例予以剔除)的肠黏膜活检组织CD3阳性淋巴细胞、肥大细胞、5-羟色胺阳性细胞及吲哚胺2,3-双加氧酶( IDO)阳性细胞数.结果 IBS患者中任意精神障碍检出比例显著高于对照组(19/43比2/15,P=0.012),其中焦虑障碍9例,心境障碍8例.IBS伴精神障碍患者在回肠末端、乙状结肠黏膜组织的肥大细胞数及5-羟色胺阳性细胞数(每高倍视野:16.7±3.6、12.8±2.2,3.7±0.9、6.1±1.8),与IBS不伴精神障碍组(每高倍视野:15.4±3.1、12.3±2.5,3.4±0.8、5.2±1.8)相比,差异均无统计学意义(均P＞0.05)；回肠末端CD3阳性淋巴细胞、IDO阳性细胞数与IBS不伴精神障碍组差异亦均无统计学意义(均P＞0.05).IBS伴焦虑障碍患者的回肠末端IDO计数显著高于IBS不伴精神障碍患者[中位数(Q1,Q3):6(4,8)比2(1,5),P=0.018].IBS伴心境障碍患者的回肠末端肥大细胞计数显著高于IBS不伴精神障碍组(每高倍视野:18.3 ±3.2比15.4±3.1,P=0.032).结论 IBS患者精神障碍可能与肠道黏膜炎症有一定关系；IDO激活可能与焦虑障碍共病,肥大细胞活化可能与心境障碍共病相关.
목적 비교장역격종합정(IBS)반정신장애여불반정신장애환자적장도점막염증지표,료해염증여IBS정신장애공병적관계.방법 순서납입2008년11월지2011년3월재북경대학제삼의원소화과문진취진、부합라마Ⅲ표준적IBS환자43례급무소화도증상적지원자(대조조)15명,유경과배훈적인원응용복합성국제진단교담표(CIDI)대기진행방담；소유납입자행결장경검사병취회장말단화결장점막활검조직,비교IBS불반정신장애(24례)급반정신장애(19례)환자여대조조(13명,유정신장애자2례여이척제)적장점막활검조직CD3양성림파세포、비대세포、5-간색알양성세포급신타알2,3-쌍가양매( IDO)양성세포수.결과 IBS환자중임의정신장애검출비례현저고우대조조(19/43비2/15,P=0.012),기중초필장애9례,심경장애8례.IBS반정신장애환자재회장말단、을상결장점막조직적비대세포수급5-간색알양성세포수(매고배시야:16.7±3.6、12.8±2.2,3.7±0.9、6.1±1.8),여IBS불반정신장애조(매고배시야:15.4±3.1、12.3±2.5,3.4±0.8、5.2±1.8)상비,차이균무통계학의의(균P＞0.05)；회장말단CD3양성림파세포、IDO양성세포수여IBS불반정신장애조차이역균무통계학의의(균P＞0.05).IBS반초필장애환자적회장말단IDO계수현저고우IBS불반정신장애환자[중위수(Q1,Q3):6(4,8)비2(1,5),P=0.018].IBS반심경장애환자적회장말단비대세포계수현저고우IBS불반정신장애조(매고배시야:18.3 ±3.2비15.4±3.1,P=0.032).결론 IBS환자정신장애가능여장도점막염증유일정관계；IDO격활가능여초필장애공병,비대세포활화가능여심경장애공병상관.
Objective To examine the relationship between inflammation and the comorbidity of mental disorders with irritable bowel syndrome (IBS) by comparing intestinal mucosa inflammatory biomarkers in patients with and without mental disorders.Methods A total of 43 consecutive IBS patients fulfilling the Rome Ⅲ criteria and 15 volunteers serving as controls without digestive symptoms were recruited and interviewed with Composite International Diagnostic Interview (CIDI) by the well-trained staff and thus classified as with or without mental disorders.All subjects underwent colonoscopy and biopsies were acquired from the mucosa of distal ileum and colon. CD3 + lymphocytes,mast cells,5-HT positive cells and (indoleamine 2,3-dioxygenase) IDO positive cells were identified immunohistologically in mucosa biopsies in volunteers (n =13 ),IBS patients without mental disorder (n =24 ) and IBS patients with mental disorder ( n =19).Results The incidence of mental disorders in IBS patients was significantly higher than that in the volunteers (19/43 vs 2/15,P =0.012),including 9 patients with anxiety disorders and 8 with mood disorders.( 1 ) The number of mast cells in IBS patients with mental disorder and that in IBS patients without mental disorder has no statistical significance ( ( 16.7 ± 3.6 )/HP vs ( 15.4 ± 3.1 )/HP in distal ileum,( 12.8 ±2.2)/HP vs ( 12.3 ± 2.5 )/HP in sigmoid,both P ＞ 0.05 ).Similar results were seen in 5-HT positive cells ( (3.7 ± 0.9 )/HP vs (3.4 ± 0.8 )/HP in distal ileum,(6.1 ± 1.8 )/HP vs(5.2 ± 1.8 )/HP in sigmoid,both P ＞ 0.05).In distal ileum,the number of CD3 + cells in IBS patients with mental disorder has no statistical significance with that in the IBS patients without mental disorder ( (62 ± 16)/HP vs(55 ±22)/HP,P ＞ 0.05 ).Similar results were seen in IDO positive cells (6 (2,8)/HP vs 2 (1,5)/HP,P ＞0.05 ).(2) The number of IDO positive cells from distal ileum in IBS patients with anxiety disorder was significantly higher than that in the IBS patients without mental disorder ( 6 ( 4,8 ) vs 2 ( 1,5 ),P =0.018).The number of mast cells from distal ileum in the IBS patients with mood disorder were significantlyhigher than that in those without mental disorders ( ( 18.3 ± 3.2)/HP vs ( 15.4 ± 3.1 )/HP,P =0.032).Conclusions Mental disorders in the IBS patients may be associated with intestinal mucosal inflammation.The activation of IDO may cause the comorbidity of IBS with anxiety disorder while the activation of mast cells probably leads to the comorbidity of IBS with mood disorder.