摘要
目的:探讨罗马Ⅳ标准下不同亚型肠易激综合征(IBS)患者肠黏膜屏障功能相关指标水平的变化及其与IBS亚型的关联.方法:纳入IBS患者77例及同时期体检的正常对照71例作为研究对象,根据Bristol粪便性状,将IBS患者分为3个亚组:腹泻型(IBS-D)31例,便秘型(IBS-C)20例、混合型(IBS-M)26例.比较患病组与健康对照组之间二胺氧化酶(DAO)、D-乳酸、细菌内毒素水平的差异及其与不同亚型IBS的关联,并用受试者工作特征(ROC)曲线分析上述指标预测IBS-D的敏感度与特异度.结果:与健康对照相比,IBS患者血清DAO、D-乳酸、细菌内毒素水平均显著增高(P<0.05);在3种不同的IBS亚型中,IBS-D组血清DAO、D-乳酸、细菌内毒素水平较IBS-C组显著增高(P<0.05),而D-乳酸、细菌内毒素水平较IBS-M组也显著增高(P<0.05);ROC曲线显示DAO、D-乳酸、细菌内毒素的曲线下面积(AUC)分别为0.813、0.834、0.865,而当三项指标作为联合预测因子时,AUC为0.898,大于使用单项指标作为预测因子的AUC.结论:IBS患者存在肠黏膜屏障功能障碍,其中肠屏损伤在IBS-D的发病中起着更为重要的作用,且DAO、D-乳酸及细菌内毒素对于临床上预测IBS-D发病具有良好的诊断价值.
Abstract
Objective:To investigate the changes in intestinal mucosal barrier function in patients with different subtypes of irritable bowel syndrome(IBS)according to Rome Ⅳ criteria and their correla-tion to the IBS subtypes.Methods:A total of 77 IBS patients and 71 normal controls at the same time were collected as research objects.According to Bristol stool characteristics,IBS patients were divided into three subgroups,including 31 cases of diarrhea type(diarrhea-predominant IBS,IBS-D),20 cases of constipation type(constipation-predominant IBS,IBS-C),and 26 cases of mixed type(mixed IBS,IBS-M).The levels of diamine oxidase(DAO),D-lactic acid(D-LA)and bacterial endotoxin between the diseased group and the healthy control group were compared,as well as their associations with differ-ent subtypes of IBS.The sensitivity and specificity of the above indicators in predicting diarrhea type of IBS were analyzed by receiver operator characteristic(ROC)curve.Results:The levels of serum DAO,D-LA,and bacterial endotoxin in IBS patients were significantly higher than those in healthy controls(P<0.05);In three different IBS subtypes,the levels of serum DAO,D-LA and bacterial endotoxin in IBS-D group were significantly higher than those in IBS-C group(P<0.05),while the levels of D-LA and bacterial endotoxin in IBS-D group were also significantly higher than those in IBS-M group(P<0.05);The ROC curve showed that the area under the curve(AUC)of DAO,D-LA,and bacterial endo-toxin was 0.813,0.834,and 0.865,respectively.When these three indicators were used as a com-bined predictive factor,the AUC was 0.898,which was greater than that of using a single indicator as a predictive factor.Conclusion:Intestinal mucosal barrier dysfunction was found in IBS,and intestinal barrier injury plays a more important role in the pathogenesis of diarrhea types,and DAO,D-LA,and bacterial endotoxin have good diagnostic value for predicting the pathogenesis of IBS-D.
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