腹泻型肠易激综合征患者内脏敏感性与直肠黏膜嗜铬细胞的相关性研究  

Correlation of visceral sensitivity and rectum mucosal enterochromaffin cells in patients with diarrhea irritable bowel syndrome

作　　者：辛海威[1] 刘心娟[1] 钱洁 尚占民[1] 裴艳香[1] Xin Haiwei;Liu Xinjuan;Qian Jie;Shang Zhanmin;Pei Yanxiang(Department of Gastroenterology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院消化内科,北京100020

出　　处：《中国医刊》2024年第6期598-601,共4页Chinese Journal of Medicine

基　　金：医院多学科临床研究创新团队项目(CYDXK202207)。

摘　　要：目的探讨腹泻型肠易激综合征(IBS-D)患者肛门直肠动力、内脏敏感性的特征性改变,以及直肠黏膜嗜铬细胞数量与内脏敏感性及症状严重程度是否存在相关性。方法纳入2021年11月至2023年1月在首都医科大学附属北京朝阳医院消化内科门诊就诊的IBS-D患者49例(IBS-D组)和健康对照者21例(对照组),均采用肠易激综合征症状严重程度量表(IBS-SSS)评估症状严重程度,并进行肛门直肠压力测定(肛管静息压、肛管最大收缩压、收缩持续时间、肛门括约肌长度、肛管松弛率)及内脏敏感性检测(初始感觉阈值、便意感阈值、最大耐受值),在结肠镜检查时用定点式活检钳取黏膜标本,行5-羟色胺(5-HT)免疫组化染色,显微镜下观察并计数5-HT反应阳性的嗜铬细胞数量。采用偏相关分析直肠黏膜嗜铬细胞数量与内脏敏感性及IBS-SSS评分之间的相关性。结果两组性别构成差异无统计学意义(P>0.05),但年龄、体重指数组间比较差异有统计学意义(P<0.05)。IBS-D组患者IBS-SSS评分明显高于对照组,初始感觉阈值、便意感阈值和最大耐受值明显低于对照组,差异均有统计学意义(P<0.05)。两组肛管最大收缩压、收缩持续时间、肛门括约肌长度比较差异无统计学意义(P>0.05),而IBS-D组肛管静息压低于对照组,肛管松弛率高于对照组(P<0.05)。IBS-D组患者肠黏膜5-HT阳性嗜铬细胞数为7.0(5.5,8.0)个/高倍视野,明显高于对照组的1.0(1.0,1.5)个/高倍视野,差异有统计学意义(P<0.05)。相关分析显示,直肠黏膜嗜铬细胞数量与初始感觉阈值、便意感阈值、最大耐受值呈负相关(P<0.05),而与IBS-SSS评分无明显相关性(P>0.05)。结论IBS-D患者内脏敏感性增高,直肠黏膜嗜铬细胞数量增多,且两者具有相关性。嗜铬细胞有望成为改善IBS-D患者内脏高敏感的治疗靶点。Objective To investigate the characteristic changes of anorectal motility and visceral sensitivity in patients with diarrhea irritable bowel syndrome(IBS-D),whether these changes are related to rectum mucosal enterochromaffin cells.Method Forty-nine patients with IBS-D admitted to Beijing Chao-Yang Hospital from November 2021 to January 2023 were assigned to the IBS-D group,and twenty-one healthy individuals were assigned to control group.The irritable bowel syndrome severity scoring system(IBS-SSS),anorectal motility,including anal resting pressure,maximum anal sphincter systolic pressure,anal sphincter length and relaxation rate were tested.In addition,initial sensory threshold,defecation threshold,and maximum tolerance value were assessed of the two groups.The biopsy samples were obtained during colonoscopy examination from rectum for detection of enterochromaffin cells by immunohistochemistry stainings with 5-HT.Partial correlation analysis was used to analyze the correlation between the number of enterochromaffin cells in rectal mucosa and visceral sensitivity.Result There was no significant difference in sex constituent ratio between the two groups(P>0.05).There were significant difference in age and BMI between the two groups(P<0.05).The scores of IBS-SSS in IBS-D group were significantly higher than those in healthy control group(P<0.05).The initial sensory threshold,defecation threshold and maximum tolerance value are lower than those in the control group(P<0.05).There were no significant differences in anorectal pressure measurement indexes such as maximum systolic pressure,duration of contraction and anal sphincter length between the two groups(P>0.05),while the resting pressure was lower than the control group and the anal canal relaxation rate in IBS-D group was higher than that in control group(P<0.05).The number of EC cells with 5-HT positive staining in IBS-D group was significantly higher than the control group[7.0(5.5,8.0)/HP vs 1.0(1.0,1.5)/HP,P<0.05].The number of EC was negatively correlated

关 键 词：腹泻型肠易激综合征 内脏敏感性 嗜铬细胞 

分 类 号：R574.4[医药卫生—消化系统]