Dunlop Simon P, Jenkins David, Neal Keith R, Spiller Robin C
Wolfson Digestive Diseases Centre, University Hospital, Nottingham, England.
Gastroenterology. 2003 Dec;125(6):1651-9. doi: 10.1053/j.gastro.2003.09.028.
BACKGROUND & AIMS: Both psychological and mucosal changes (increased enterochromaffin [EC] cells and T lymphocytes) have been associated with postinfectious irritable bowel syndrome (PI-IBS). However, previous studies have been underpowered to determine the relative importance of these changes in predicting the development of PI-IBS. Our aim was to prospectively determine the relative importance of both psychological and histologic factors in the development of PI-IBS after Campylobacter infection.
Questionnaires detailing psychological and bowel symptoms were sent to 1977 patients 3 months after infection. Twenty-eight patients with new-onset PI-IBS, 28 age- and sex-matched patient controls who were asymptomatic after infection, and 34 healthy volunteers underwent rectal biopsy, which was assessed for serotonin-containing EC cells, mast cells, and lamina propria T lymphocytes.
PI-IBS, predominantly of the diarrhea-predominant subtype, occurred in 103 of 747 (13.8%) of those infected. EC cell counts per high-power field (hpf) were higher in patients with PI-IBS (35.8 +/- 1.2) compared with patient controls (30.6 +/- 1.9; P = 0.022) and volunteers (29.1 +/- 1.8; P = 0.006). Lamina propria T lymphocytes per hpf were higher in patients with PI-IBS (127.1 +/- 8.7) and patient controls (113.4 +/- 6.2) in contrast to healthy volunteers (97.1 +/- 5.7) (P = 0.006 and P = 0.058, respectively). Anxiety, depression, and fatigue were significantly increased in patients with PI-IBS compared with patient controls. Multivariate analysis indicated that increased EC cell counts and depression were equally important predictors of developing PI-IBS (relative risk, 3.8 and 3.2 for each standard deviation increase in respective values).
Both increased EC cells and depression are important independent predictors of developing PI-IBS.
心理变化和黏膜改变（肠嗜铬细胞[EC]和T淋巴细胞增多）均与感染后肠易激综合征（PI-IBS）有关。然而，既往研究的样本量不足以确定这些变化在预测PI-IBS发生中的相对重要性。我们的目的是前瞻性地确定心理因素和组织学因素在弯曲杆菌感染后PI-IBS发生中的相对重要性。
在感染后3个月，向1977例患者发送了详细询问心理和肠道症状的问卷。28例新发PI-IBS患者、28例年龄和性别匹配且感染后无症状的患者对照以及34名健康志愿者接受了直肠活检，评估活检组织中含5-羟色胺的EC细胞、肥大细胞和固有层T淋巴细胞。
747例感染者中有103例（13.8%）发生了PI-IBS，主要为腹泻型。与患者对照（30.6±1.9；P = 0.022）和志愿者（29.1±1.8；P = 0.006）相比，PI-IBS患者每高倍视野（hpf）的EC细胞计数更高（35.8±1.2）。与健康志愿者（97.1±5.7）相比，PI-IBS患者（127.1±8.7）和患者对照（113.4±6.2）每hpf的固有层T淋巴细胞更多（P分别为0.006和0.058）。与患者对照相比，PI-IBS患者的焦虑、抑郁和疲劳明显增加。多因素分析表明，EC细胞计数增加和抑郁是发生PI-IBS的同等重要的预测因素（各自值每增加一个标准差，相对风险分别为3.8和3.2）。
EC细胞增多和抑郁都是发生PI-IBS的重要独立预测因素。
