腹泻型肠易激综合征患者血清抗肠神经元抗体免疫反应特点及其临床意义  

Characteristics and clinical significance of sera anti-enteric neuronal antibodies in patients with irritable bowel syndrome with diarrhea

作　　者：陈玲玲[1,2] 文平[1] 费贵军[1] 王承党[2] 辛海威[1] 朱丽明[1] 方秀才[1] CHEN Ling-ling WEN Ping FEI Gui-jun WANG Cheng-dang XIN Hai-wei ZHU Li-ming FANG Xiu-cai(Dept. of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730 Dept. of Gastroenterology, the Digestive Diseases Lab, the First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou 350005, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [2]福建医科大学附属第一医院消化内科福建医科大学消化系病研究室,福建福州350005

出　　处：《基础医学与临床》2017年第2期156-161,共6页Basic and Clinical Medicine

基　　金：国家国际科技合作专项项目(2014DFA31850);国家自然科学基金(30971347;81370488)

摘　　要：目的通过检测腹泻型肠易激综合征(IBS-D)患者血清中抗肠神经元抗体(AENA),分析与症状的相关性,探讨AENA在IBS发病中的可能作用。方法纳入符合罗马Ⅲ诊断标准IBS-D患者和健康对照者,采集血清,以豚鼠黏膜下神经丛为底物,间接免疫荧光法检测血清AENA,盲法判断免疫反应染色结果;比较AENA阳性和阴性/弱阳性IBS-D患者临床症状的差别。结果 1)127例IBS-D患者AENA阳性率为85.8%;86名健康对照者阳性率为7.0%。109例AENA阳性的IBS-D患者血清分别为强阳性23.6%、阳性43.3%、弱阳性18.9%,表现为单纯胞质染色、单纯胞核染色、胞质和胞核染色、核膜染色、胞质和核膜染色;6名AENA阳性的健康对照血清均为单纯胞质染色。2)AENA强阳性的IBS-D患者,其肠道症状重于抗体阴性和弱阳性患者,表现为肠道症状计分高分(>10分者,58.8%比38.1%)、平素腹痛频发(91.7%比60.0%)、排便前腹痛/腹部不适严重的患者比例数高(24.7%比9.5%);AENA阳性IBS-D患者排便急迫感更常见(87.3%比57.1%)。结论 AENA在IBS发病中可能起一定作用,其有望成为IBS-D的生物学标志。Objective To detect the sera anti-enteric neuronal antibodies（ AENA） in irritable bowel syndrome with diarrhea（ IBS-D） patients and analyzed its correlation with IBS-D symptoms to explore the potential roles of AENA in the pathogenesis of IBS. Methods IBS-D patients diagnosed with Rome Ⅲ diagnostic criteria were enrolled in this study. The sera of healthy subjects were used as controls. Indirect immunofluorescence（ IIF） was used to detect the sera AENA with the substrate of ileal submucosal plexus of guinea pig. The immune reactivity（ IR） stains were read in blinded method. The bowel symptoms of patients with positive AENA were compared to that with negative and weekly positive antibodies. Results 1） A total of 127 IBS-D patients were enrolled in this study. The positive rate of sera AENA was 85. 8% in IBS-D patients,and 7. 0% in healthy controls. Among 109IBS-D patients with positive IIF reactivity,23. 6% present with strong positive,43. 3% with positive and 18. 9%with weakly positive stain. The IR patterns included cytoplasm staining,nucleus staining,cytoplasms and nuclei staining,nuclear membrane staining,cytoplasm and nuclear membrane staining. Six positive sera of healthy control showed cytoplasm staining to substrate neurons. 2） More patients of IBS-D with positive IR had higher intestinal symptoms scores（ 〉10 scores,58. 8% vs 38. 1%）,frequent abdominal pain in non-defecation period（ 91. 7% vs60. 0%）,and severe abdominal pain / discomfort before defecation（ 24. 7% vs 9. 5%） comparing to those with negative and weekly positive IR of AENA; IBS-D patients with positive IR of AENA are more commonly associated with urgency comparing to those with negative IR in IIF（ 57. 1% vs 87. 3）. Conclusions AENA may play a role in the pathogenesis of IBS,and is a potential biomarker of IBS-D.

关 键 词：肠易激综合征 抗肠神经元抗体 肠神经系统 生物学标志物 

分 类 号：R574.4[医药卫生—消化系统]