Dinan Timothy G, Quigley Eamonn M M, Ahmed Salah M M, Scully Paul, O'Brien Sinead, O'Mahony Liam, O'Mahony Siobhan, Shanahan Fergus, Keeling P W Napoleon
Alimentary Pharmabiotic Centre, University College Cork, Ireland.
Gastroenterology. 2006 Feb;130(2):304-11. doi: 10.1053/j.gastro.2005.11.033.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a functional disorder with an etiology that has been linked to both psychological stress and infection. The primary aim of this study was to examine the hypothalamic-pituitary-adrenal axis in patients with IBS and to relate such response to plasma cytokine profiles.
A total of 151 subjects, 76 patients and 75 controls, were recruited. The patients with IBS were diagnosed according to Rome II criteria. Forty-nine patients and 48 matched controls had cytokine levels measured, and a subset of 21 patients and 21 controls also underwent a corticotropin-releasing hormone (CRH) stimulation test with plasma levels of adrenocorticotropic hormone (ACTH) and cortisol measured. The remaining 27 patients and 27 controls underwent a dexamethasone (1 mg) challenge.
Cortisol and the proinflammatory cytokines interleukin (IL)-6 (together with its soluble receptor) and IL-8 were elevated in all IBS subgroups (diarrhea predominant, constipated, and alternators), although the elevation was most marked in the constipated subgroup. There was no alteration in the anti-inflammatory cytokine IL-10. Following CRH infusion, an exaggerated release of both ACTH and cortisol was observed in patients with IBS. There was a significant correlation between the ACTH response (deltaACTH) and the IL-6 levels. A similar relationship existed between the deltaACTH/deltacortisol ratio and the IL-6 levels. Dexamethasone suppression of cortisol was similar in patients and controls.
IBS is characterized by an overactivation of the hypothalamic-pituitary-adrenal axis and a proinflammatory cytokine increase.
肠易激综合征（IBS）是一种功能性疾病，其病因与心理压力和感染均有关联。本研究的主要目的是检测IBS患者的下丘脑 - 垂体 - 肾上腺轴，并将这种反应与血浆细胞因子谱相关联。
共招募了151名受试者，其中76例患者和75例对照。IBS患者根据罗马II标准进行诊断。49例患者和48例匹配对照检测了细胞因子水平，21例患者和21例对照的亚组还进行了促肾上腺皮质激素释放激素（CRH）刺激试验，检测血浆促肾上腺皮质激素（ACTH）和皮质醇水平。其余27例患者和27例对照进行了地塞米松（1毫克）激发试验。
所有IBS亚组（腹泻型、便秘型和交替型）的皮质醇以及促炎细胞因子白细胞介素（IL）-6（及其可溶性受体）和IL-8均升高，尽管便秘型亚组的升高最为明显。抗炎细胞因子IL-10无变化。输注CRH后，IBS患者观察到ACTH和皮质醇的过度释放。ACTH反应（deltaACTH）与IL-6水平之间存在显著相关性。deltaACTH/deltacortisol比值与IL-6水平之间也存在类似关系。患者和对照中地塞米松对皮质醇的抑制作用相似。
IBS的特征是下丘脑 - 垂体 - 肾上腺轴过度激活和促炎细胞因子增加。
