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肠易激综合征中西医结合诊治方案(草案)
概念肠易激综合征(irritable bowel syndrom, IBS)是一种以长期或反复发作的腹痛、腹胀,伴排便习惯和大便性状异常而目前尚缺乏形态学、细菌学和生化学指标异常的肠功能障碍性综合征.
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加味二至丸治疗便秘型肠易激综合征验案举隅
二至丸出自<医方集解>,由女贞子、旱莲草二味药物组成,具有补腰膝、壮筋骨、强肾阴、乌须发的功效.临床上常用于肝肾阴虚、头晕眼花、失眠多梦、腰膝疲软、遗精、须发早白等症.笔者用本方加枳实、火麻仁治疗便秘型肠易激综合症疗效显著,介绍如下.
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便秘型肠易激综合征新概念模型的建立
目的:以肠易激综合征(IBS)模型新概念建立一种便秘型IBS大鼠模型,为IBS的研究提供新的条件.方法:出生后4 wk Wistar大鼠,随机分为冰水灌胃组、常温水灌胃组及正常对照组.前两组每日分别给予冰水及常温水灌胃14 d,观察灌胃期间三组大鼠灌胃后3 h内和3-24 h间的大便粒数及含水量变化,停止灌胃后继续观察14 d对应时间段的大便粒数及含水量变化以评价其便秘.28 d观察结束后给予直肠内球囊扩张,测定引起腹部收缩反射的小容量阈值及直肠内球囊不同容量扩张时腹部收缩反射的次数,评价其肠道对扩张刺激的敏感性.各组动物回盲部及结肠肥大细胞(MC)研究应用甲苯胺蓝染色、计数.5-羟色胺(5-HT)在肠道的表达应用免疫组织化学染色及彩色病理图像分析系统进行半定量分析.结果:冰水灌胃组大鼠灌胃后3 h内大便粒数及含水量较常温水灌胃组和正常对照组明显增加(P<.05);停止灌胃后三组大鼠对应时间段3 h内大便粒数及含水量无明显差异(P>.05).冰水灌胃组前14 d灌胃后3-24 h间的大便粒数及含水量均较常温水灌胃组和正常对照组明显减少(P<0.05);停止灌胃后,此趋势继续保持至第28 d实验结束.直肠内球囊扩张时,冰水灌胃组引起腹部收缩的小容量阈值略高于正常对照组,但统计学比较无明显差异(P>0.05).直肠球囊体积1.0 mL低容量扩张时冰水灌胃组3 min内腹部收缩反射次数明显低于正常对照组(P<0.05);球囊体积1.5 mL,2.0 mL高容量扩张时两组无明显差异(P>0.05).冰水灌胃组回盲部和结肠MC计数均明显高于正常对照组(P<0.05).冰水灌胃组回盲部、结肠黏膜层5-HT阳性细胞的面积均明显高于正常对照组(P<0.05).结论:采用冰水灌胃法建立了大鼠便秘模型,该模型具有肠道敏感性降低、回盲部及结肠MC增多、5-HT阳性内分泌细胞增多,较好地模拟了人的C-IBS特征,显示了IBS动物模型的新概念.
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心理社会因素对肠易激综合征患者生活质量的影响
目的:探讨影响就诊肠易激综合征(IBS)患者生活质量的心理社会因素.方法:采用肠易激综合征生活质量量表、心理学症状自评量表(SCL-90)、生活事件量表、特质应对方式问卷、应付方式问卷、社会支持评定量表及匹兹堡睡眠质量指数对符合罗马Ⅱ标准连续在消化专科门诊的41例IBS患者进行测评,并与同期诊断的匹配的37名健康自愿者对照.通过多元逐步回归分析探讨心理行为因素对患者生活质量的影响.结果:与正常组相比,IBS组生活质量的8个因子和总分均显著降低(P<0.05),其中即烦躁不安、冲突行为、社会反应、健康忧虑降低为明显(P=0.000).此外,IBS患者精神症状明显(40.2±4.5,t=2.63,P=0.047),焦虑0.67±0.30,t=2.16,P=0.016)和抑郁(0.64±0.24,t=2.53,P=0.020)积分也显著增高.1BS患者的消极应对(40.8±8.0,P<0.05),幻想(4.95±2.1,P=0.001)和退避(4.81±2.1,P=0.004)以及主观支持(23.9±4.2,P=0.046)积分均明显高于正常人.同时IBS患者的睡眠质量、日间功能显著降低,PSQI、睡眠障碍积分和安眠药应用显著增加.多元回归分析显示IBS患者的生活质量降低与睡眠质量(β=0.281)和负性生活事件(β=-0.363)及焦虑状态(β=-0.175)关系更为密切.结论:IBS患者生活质量降低与多种心理社会参数异常呈明显的负相关.
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应用SF-36生活质量对肠易激综合征进行疗效评价
目的:采用SF-36生活质量和临床症状综合评价不同疗法对肠易激综合征(IBS)患者的疗效.方法:2001-01/2002-01消化科门诊符合罗马Ⅱ标准的IBS患者172例,按排便习惯分为便秘为主型、腹泻为主型和腹泻便秘交替型,分别修稿一种方案治疗,疗程为8 wk.方案A:匹维溴胺(100mg,3次/d);方案B:匹维溴胺(100mg,3次/d)+多虑平(25 mg,晚服);方案C:安慰剂对照组.分别记录治疗前后患者SF-36生活质量评分和症状积分.结果:A方案症状显效率和总有效率分别为40.5%和73.0%;B方案分别为65.4%和88.5%;C方案分别为30.5%和47.9%.A,B方案总有效率均显著高于C方案(P=0.046和0.002),B方案与A,C方案显效率均有显著差异(P=0.045和0.015).A,B方案对生活质量的改善优于C方案,以B方案对各个纬度的生活质量改善为明显.B方案治疗后,躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)和精神健康(MH)维度的积分有显著提高(P<0.05),且患者的生理功能(PF)、生理职能(RP)、总体健康(GH)、活力(VT)、情感职能(RE)和精神健康(MH)6个维度的生活质量甚至接近杭州市普通人群的生活质量(P>0.05).三种不同亚型患者症状总有效率、显效率均无显著的统计学差异(P>0.05).症状疗效和生活质量改善呈一定的相关性,但相关无统计学意义(P>0.05).结论:综合SF-36生活质量标准和症状疗效,可全面评价IBS疗效.联合匹维溴胺和抗抑郁药对改善患者的生活质量和IBS症状疗效佳.
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肠易激综合征患者肠黏膜肥大细胞的变化
目的:探讨肠易激综合征(irritable bowel syndrome,IBS)与肠黏膜肥大细胞(mast cell,MC)及脱颗粒之间的关系.方法:正常人10例和IBS患者20例(腹泻11例,便秘9例).每例于结肠镜下取盲肠、横结肠和直肠各2块,用免疫组化方法行MC染色,计算每高倍视野下MC的数量及脱颗粒MC所占MC总数的比例.结果:腹泻组IBS患者盲肠、横结肠黏膜MC数量显著高于正常对照组(P<0.01及P<0.05);直肠黏膜MC数量与正常对照组无显著差异(P>0.05).便秘组IBS患者在盲肠黏膜MC数量显著高于正常对照组(P<0.05),而横结肠、直肠黏膜MC数量与正常对照组无显著差异(P>0.05).盲肠腹泻组IBS患者盲肠MC数量显著高于便秘组(P<0.05),而在横结肠及直肠两组之间无显著差异.腹泻型IBS患者盲肠、横结肠、直肠黏膜脱颗粒MC比率显著高于正常对照组(P<0.05或P<0.01);便秘组IBS患者盲肠、直肠黏膜脱颗粒MC比率亦高于正常对照组(P<0.05),而在横结肠与正常对照组无显著差异(P>.05);各部位肠黏膜腹泻组型IBS患者脱颗粒MC比率显著高于便秘组.结论:肠黏膜肥大细胞可能参与IBS的发病.
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肠易激综合征内脏高敏感性发生的神经与心理机制研究进展
肠易激综合征(imitable bowel ayndrome,IBS)是一组以腹痛、腹泻、排便异常等症状为特征的肠道功能性疾病.其中腹痛被认为与患者增加的内脏敏感性密切相关.1973年,Ritchie[1]第一次报道IBS患者对结肠扩张性刺激的内脏敏感性高于正常对照组.随后越来越多的研究支持这一观点,即IBS患者具有内脏高敏感.
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肠易激综合征的药物治疗进展
肠易激综合征(Irritable bowel syndrome,IBS)属功能性胃肠道疾病,是一组表现为腹痛、腹胀、便秘、腹泻或便秘与腹泻交替,又缺少形态学或生化学异常的综合征.IBS全球发病率很高,各地发病率在10%~20%之间.目前,该病通用的诊断标准为罗马Ⅱ标准,在诊断过程中不必进行过多的检查,如果患者年龄小于50岁,存在典型症状而没有报警症状,则可依据症状做出IBS的诊断.
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Objective:To observe the clinical effect of acupuncture and moxibustion on diarrhea-predominant irritable bowel syndrome (IBS-D).
Methods: A total of 60 IBS-D patients were randomly allocated into a treatment group and a control group, 30 in each group. Patients in the treatment group were treated with acupuncture combined with ginger and salt-partitioned moxibustion on Shenque (CV 8), whereas patients in the control group only received acupuncture treatment. Six days made up a course of treatment, and the clinical effects were statistically analyzed after 4 courses.
Results: The overall response rate in the treatment group was 96.7%, versus 76.7% in the control group, showing a statistical significance (P<0.05). In the intra-group comparison of the symptom scores after treatment, there were statistical differences in both groups (both P<0.01), and in the inter-group comparison, the difference was statistically significant (P<0.05).
Conclusion: Acupuncture combined with ginger and salt-partitioned moxibustion on Shenque (CV 8) can obtain better effect for ISB-D than acupuncture alone. -
Effect of Electroacupuncture on Chronic Visceral Pain and Involvement of Spinal NMDA Receptor in IBS Rats
Objective:To clarify effect of electroacupuncture (EA) on relieving chronic visceral pain and the underlying neurobiological mechanism for such an effect,we observed the effect of EA on the Irritable bowel syndrome (IBS) rat and then examined spinal expression of N-methyl-D-aspartate (NMDA)receptor-1 in rats.Methods:Daily mechanical colon distention was performed on male Sprague-Dawley neonatal rats to produce IBS model.EA was applied at acupoints of Zusanli (ST 36) and Shangjuxu (ST 37)in each hind leg.Abdominal withdrawal reflex (AWR) assessment or rectus abdominis electromyograms (AEMG) recordings were then performed after EA treatment.The mRNA expression of the NMDA subtype of glutamate receptors in the spinal dorsal horn (L4-5) before and after EA was investigated by RT-PCR analysis in IBS rats.Results:The results demonstrated that EA could significantly decreased both AWR scores from behavioral test and AEMG discharges from electrophysiological recording in IBS model rats elicited by colorectal distension (CRD) stimuli with strengths of 20,40,60 and 80 mmHg,respectively (P<0.05).Meanwhile there was a significant decrease in mRNA expression of NMDA receptor-1 in the spinal dorsal horn of IBS rats treated by EA (P<0.05),but no such effect was observed in IBS rats treated by sham EA (inserting needles without electrical stimulation).Conclusion:These results indicate that EA can relieve chronic visceral hyperalgesia in IBS rats and this effect might be correlated with the down-regulation of NMDA receptor-1 in the dorsal hom of the spinal cord.
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重视肠易激综合征的诊断和治疗
肠易激综合征(irritable bowel syndrome, IBS)是消化系统常见的功能性疾病之一,其以反复发作腹痛和(或)腹部不适、排便习惯改变为主要特征,而无器质性病理改变.由于没有特异的生物学标志,不同个体临床表现多样化,因而如何正确诊断IBS以及在此基础上给予规范的治疗一直是临床工作的一大难点.临床实践中,由于诊断和治疗的随意性,IBS常常出现误诊误治的情况,治疗效果也不尽如人意,这是临床上应该引起重视并亟待解决的问题.
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重视肠黏膜免疫在肠易激综合征发病机制中的作用
肠易激综合征(IBS)是临床上为常见的肠道功能性疾病之一,是指一组包括腹痛、腹胀及排便习惯改变、粪便性状异常为临床表现的症候群.既然定义为一种功能性疾病,首先应该排除形态学、生物化学代谢等方面的异常.关于IBS诊断标准如Manning标准、罗马标准Ⅰ~Ⅲ的不断演变也以排除器质性疾病为前提.尽管如此,近年来对IBS的研究早已超越了动力理论的范畴,更加关注与免疫、炎症、遗传相关的分子生物学机制.目前研究普遍认为,功能的异常必然有其物质的基础,只是尚未发现其关键组织细胞或分子的改变.
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感染后肠易激综合征患者肠黏膜细胞因子表达的相关性研究
临床发现,约1/3的肠易激综合征(irritable bowel syndrome,IBS) 患者在其患病前曾有急性胃肠道感染史;部分被肠道病毒、细菌或寄生虫感染的患者,在病原体已清除及黏膜炎症消退后,可发生IBS样的症状,称之为感染后肠易激综合征(postinfectious irritable bowel syndrome, Pl-IBS)~([1]).
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细胞因子在感染后肠易激综合征及溃疡性结肠炎缓解期肠黏膜中的表达
临床发现约1/3肠易激综合征(irritable bowel syndrome,IBS)患者患病前曾有急性胃肠道感染史,称之为感染后肠易激综合征(post-infective irritable bowel syndrome,PI-IBS)[1].
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This study was undertaken to evaluate the inlfuence of treatment with rifaximin followed by the probiotic VSL#3 versus no treatment on the progression of chronic prostatitis toward chronic microbial prostate?vesiculitis(PV) or prostate?vesiculo?epididymitis(PVE). Atotal of 106 selected infertile male patients with bacteriologically cured chronic bacterial prostatitis(CBP) and irritable bowel syndrome (IBS) were randomly prescribed rifaximin(200mg, 2 tablets bid, for 7days monthly for 12months) and probiotic containing multiple strains VSL#3(450×109 CFU per day) or no treatment. Ninety?ifve of them(89.6%) complied with the therapeutic plan and were included in this study. GroupA = “6Tx/6?”: treatment for the initial 6 and no treatment for the following 6months(n=26); GroupB = “12Tx”: 12months of treatment(n=22); GroupC = “6?/6Tx”: no treatment for the initial 6months and treatment in the last 6months(n=23); GroupD = “12?”: no treatment(n=24). The patients of GroupsA = “6Tx/6?” and B= “12Tx” had the highest frequency of chronic prostatitis(88.5% and 86.4%, respectively). In contrast, group “12?”: patients had the lowest frequency of prostatitis(33.4%). The progression of prostatitis into PV in groups “6Tx/6?”(15.5%) and “6?/6Tx”(13.6%) was lower than that found in the patients of group “12?”(45.8%). Finally, no patient of groups “6Tx/6?” and “6?/6Tx” had PVE, whereas it was diagnosed in 20.8% of group “12?” patients. Long?term treatment with rifaximin and the probiotic VSL#3 is effective in lowering the progression of prostatitis into more complicated forms of male accessory gland infections in infertile patients with bacteriologically cured CBP plus IBS.
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上期《社区肠易激综合征老年病人的病例讨论》问题的参考答案
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社区肠易激综合征老年病人的病例讨论
患者,男性,74岁,常规来全科医生处体检.患者自诉反复便秘和腹泻60余年.患者60余年前无明显诱因下出现便秘和腹泻反复发生.有时大便时肛门疼痛,为撕裂样,便时疼痛,便后消失.大便次数较少,质地很硬,约3~5 d一次,大便表面和手纸上有新鲜血.
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肠易激综合征神经免疫内分泌网络调控机制
肠易激综合征(irritable bowel syndrome,IBS)是常见的消化疾病之一.西方国家约15%~20%的人患有IBS,我国IBS的发病率具体不详,北京地区约为7%.
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肠易激综合征治疗新进展
肠易激综合征(irritable bowel syndrome ,IBS)是一种功能性胃肠疾病,其特点为反复发作的腹痛和肠道功能的改变,且缺乏生化或器质性病理变化[1]。目前其发病机制还不清楚,可能的发病机制包括内脏高敏感性、蠕动障碍、社会心理学因素、基因和环境因素、脑‐肠轴紊乱和肠内细菌改变等[2]。根据罗马诊断标准,IBS 可分为便秘型(constipation‐predominant irritable bowel syndrome ,IBS‐C)、腹泻型(diarrhea‐predominant irritable bowel syndrome ,IBS‐D)和混合型[3]。据调查,IBS在全球的发病率为10%~15%[4],在东亚的发病率为5%~10%[5]。它不仅直接产生巨大的医疗花费,还间接通过影响人的生产力而造成损失[6]。IBS的传统治疗以改善症状为主,主要包括止泻、缓泻、解痉、镇静、抗抑郁、抗焦虑等对症治疗。但对于大部分患者来说,传统药物的治疗效果有限[7]。现在一些新的治疗方法逐渐出现并趋向成熟,本文就近年来IBS治疗的新进展概述如下。
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The role of functional polymorphisms of HTT-LPR and COMT in the occurrence of irritable bowel syndrome amongst children