De Silva Arjuna Priyadarsin, Nandasiri Shanika Dulanjalee, Hewavisenthi Janaki, Manamperi Aresha, Ariyasinghe Madurangi Prasadi, Dassanayake Anuradha Supun, Jewell Derek P, de Silva Hithanadura Janaka
Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Scand J Gastroenterol. 2012 Jun;47(6):619-24. doi: 10.3109/00365521.2012.666672. Epub 2012 Apr 10.
There is evidence for low-grade inflammation in the pathophysiology of post-infectious irritable bowel syndrome (IBS). We assessed the degree of subclinical intestinal mucosal inflammation in diarrhea-predominant IBS (IBS-D) in a tropical setting.
In a prospective study over 1 year, we investigated 49 patients with IBS-D (cases; median age 34 years (range 18-59); M:F 36:13), diagnosed on Rome III criteria. 14 individuals with a family history of colon cancer (median age 46.5 years (range 23-56); M:F 6:8) were selected as controls. Stools of cases and controls were tested for calprotectin. During colonoileoscopy, serial biopsies were obtained. Mucosal mast cells, neutrophils, eosinophils and lymphocytes/plasma cell infiltrate were quantified. Tissue expression of IL-8 and IL-10 was assessed in biopsies by semi-quantitative RT-PCR.
A history suggestive of an episode of infectious diarrhea (ID) was present in 16/49 cases and 0/14 controls (p = 0.013). In cases, there were significantly more mucosal mast cells in the ileum and all segments of colon and significantly more eosinophils in the cecum. Tissue expression of IL-8 was significantly higher and IL-10 significantly lower in cases compared with controls (target/standard cDNA ratio, median (range) IL-8: 1.25 (0.75-2) vs. 0.85 (0.63-1.3), p < 0.0001, Mann-Whitney U test; IL-10: 0.33 (0-0.63) vs. 0.55 (0.5-0.7), p < 0.0001). There was a significant inverse correlation between IL-8 and IL-10 expression (Pearson correlation, (-) 0.509; p < 0.01).
There was evidence of subclinical intestinal mucosal inflammation in patients with IBS-D. The finding of increased eosinophils is novel, and may be of special relevance to IBS-D in the tropics.
有证据表明，低度炎症存在于感染后肠易激综合征（IBS）的病理生理过程中。我们评估了热带地区以腹泻为主型肠易激综合征（IBS-D）患者亚临床肠道黏膜炎症的程度。
在一项为期1年的前瞻性研究中，我们调查了49例符合罗马Ⅲ标准诊断的IBS-D患者（病例组；中位年龄34岁（范围18 - 59岁）；男:女为36:13）。选取14例有结肠癌家族史的个体（中位年龄46.5岁（范围23 - 56岁）；男:女为6:8）作为对照组。对病例组和对照组的粪便进行钙卫蛋白检测。在结肠镜检查过程中，获取系列活检组织。对黏膜肥大细胞、中性粒细胞、嗜酸性粒细胞以及淋巴细胞/浆细胞浸润情况进行定量分析。通过半定量逆转录聚合酶链反应（RT-PCR）评估活检组织中白细胞介素-8（IL-8）和白细胞介素-10（IL-10）的组织表达情况。
16/49例病例有提示感染性腹泻（ID）发作的病史，而14例对照组中无此情况（p = 0.013）。在病例组中，回肠及结肠各段的黏膜肥大细胞显著增多，盲肠中的嗜酸性粒细胞显著增多。与对照组相比，病例组中IL-8的组织表达显著升高，IL-10的组织表达显著降低（目的/标准互补脱氧核糖核酸（cDNA）比值，中位值（范围）IL-8：1.25（0.75 - 2）vs. 0.85（0.63 - 1.3），p < 0.0001，曼-惠特尼U检验；IL-10：0.33（0 - 0.63）vs. 0.55（0.5 - 0.7），p < 0.0001）。IL-8和IL-10的表达之间存在显著的负相关（皮尔逊相关性，(-) 0.
