感染后肠易激综合征与非感染后肠易激综合征临床差异分析

摘要

目的 探讨感染后肠易激综合征(PI-IBS)与非感染后肠易激综合征(NPI-IBS)的临床差异.方法 收集解放军总医院2010年至2013年确诊并治疗的PI-IBS患者(PI-IBS组)117例、非感染后IBS患者(NPI-IBS组)201例,以及31例健康体检人员(健康对照组)的临床资料和治疗前血清样本,分析各组临床特征和血清肠脂肪酸结合蛋白(I-FABP)水平的差异.结果 (1)PI-IBS组患者的IBS发病至就诊时间长于NPI-IBS组[(19.7±10.3)个月比(11.4±5.3)个月,P＜0.05],伴焦虑状态[焦虑自评量表(SAS)评分＞50分]的比例明显高于NPI-IBS组[58.1％ (68/117)比28.9％(58/201),P＜0.05];两组的男女性别比、发病年龄、IBS分型、胃肠道症状分级量表(GSRS)评分的差异无统计学意义.(2) PI-IBS组血清I-FABP水平明显高于NPI-IBS组和健康对照组[(42.6±14.8)μg/L比(17.3 ±11.5)μg/L和(10.6±8.2) μg/L,P均＜0.05],NPI-IBS组和健康对照组的血清I-FABP水平无明显差异(P＞0.05).(3)PI-IBS组腹泻型IBS(IBS-D亚型)患者血清I-FABP水平明显高于NPI-IBS组IBS-D亚型患者[(54.8 ±9.3)μg/L比(12.3±6.2) μg/L,P＜0.05],两组间便秘型IBS(IBS-C亚型)和混合型IBS(IBS-M亚型)患者的血清I-FABP水平无明显差异(P均＞0.05).结论 PI-IBS患者病程长、多伴有焦虑状态,且存在隐匿性肠道炎症,伴有肠黏膜上皮损伤.血清I-FABP有望成为PI-IBS检测指标.%Objective To study the clinical discrepancy between patients with post infectious irritable bowel syndrome(PI-IBS) and non post infectious irritable bowel syndrome(NPI-IBS),and assess the value of serum intestinal fatty acid binding protein (I-FABP) for differential diagnosis.Methods A total of 117 patients with PI-IBS,201 patients with NPI-IBS and 31 healthy controls were prospectively recruited in General Liberation Army Hospital from 2010 to 2013.Plasma samples and clinical data were collected.Serum I-FABP level was measured by an enzyme-linked immunosorbent assay.Results The median age of patients with PI-IBS was 36 years.The median time to diagnosis in PI-IBS group was significantly longer than that in NPI-IBS group [(19.7 ± 10.3) months vs (11.4 ± 5.3) months,P ＜ 0.05].Similarly,the proportion of anxiety [58.1％ (68/117) vs 28.9％ (58/201),P ＜ 0.05] and the value of I-FABP[(42.6 ± 14.8) μg/L vs (17.3 ± 11.5) μg/L,P ＜ 0.05] in PI-IBS group were significant higher than NPI-IBS patients.The level of I-FABP of healthy controls [(10.6 ± 8.2) μg/L] was also significantly lower than that of PI-IBS patients (P ＜ 0.05),yet no difference from that of NPI-IBS group.The I-FABP value of subgroup PI-IBS patients with diarrhoea (IBS-D) was significant higher than that of NPI-IBS group [(54.8 ± 9.3) μg/L vs (12.3 ± 6.2) μg/L,P ＜ 0.05].However,other parameters including gender,age,GSRS score,and I-FABP value of subgroup constipation (IBS-C) and mix (IBS-M),were not different between PI-IBS group and NPI-IBS group (all P ＞ 0.05).Conclusion PI-IBS is an occult intestinal inflammation disease with mucosa injury.I-FABP might be a potential testing marker for the diagnosis of PI-IBS.