产志贺样毒素大肠杆菌（STEC）O104：H4 感染后感染后肠易激综合征（PI-IBS）：前瞻性随访队列研究。
Post-infectious irritable bowel syndrome (PI-IBS) after infection with Shiga-like toxin-producing Escherichia coli (STEC) O104:H4: A cohort study with prospective follow-up.
机构信息
Department of Gastroenterology and Infectious Diseases; Israelitic Hospital Hamburg and.
Department of Psychosomatic Medicine and Psychotherapy; Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
出版信息
United European Gastroenterol J. 2016 Feb;4(1):121-31. doi: 10.1177/2050640615581113. Epub 2015 Apr 28.
BACKGROUND
In May/June 2011, the new Shiga-like toxin-producing Escherichia coli (STEC) strain O104:H4 caused the severest outbreak ever recorded of hemorrhagic enterocolitis in 3842 patients in Germany.
OBJECTIVES
As bacterial enterocolitis is an established risk factor of subsequent irritable bowel syndrome (IBS), we aimed to estimate prevalence and incidence of post-infectious (PI)-IBS after six and 12 months in a cohort of STEC O104:H4 patients and to prospectively identify associated somatic and psychometric risk factors.
METHODS
A total of 389 patients were studied prospectively at baseline and at six and 12 months after STEC infection using STEC disease-related questionnaires and validated instruments for IBS (Rome III) and psychological factors. Frequencies and logistic regression models using multiple imputations were applied to assess predictor variables.
RESULTS
Prevalence of IBS increased from 9.8% prior to STEC infection to 23.6% at six and 25.3% at 12 months after STEC infection. In patients without IBS symptoms prior to STEC infection, incidence of new IBS was 16.9%. Logistic regression models indicated higher somatization and anxiety scores as risk factors for, and mesalazine treatment during, STEC infection as the only significant protective factor against IBS. No other factor analyzed, including disease severity, showed an association.
CONCLUSIONS
PI-IBS rates following this unusually severe STEC outbreak were similar to what has been observed after other infectious gastroenteritis outbreaks. Our findings suggest that mesalazine may have reduced the risk of subsequent PI-IBS. As altered mucosal immune activity is a pivotal pathogenic factor in PI-IBS, our observation of a potential protective effect of mesalazine might be explained by its known modulatory action on mucosal immunity, and may warrant further investigation.
背景
2011 年 5 月/6 月，新型产志贺样毒素大肠杆菌（STEC）O104：H4 菌株引发了德国 3842 例出血性肠炎患者有史以来最严重的爆发。
目的
由于细菌性肠炎是随后发生肠易激综合征（IBS）的既定危险因素，我们旨在估计 STEC O104：H4 患者队列中感染后 6 个月和 12 个月时感染后（PI）-IBS 的患病率和发病率，并前瞻性地确定相关的躯体和心理计量学危险因素。
方法
共对 389 例患者进行前瞻性研究，在 STEC 感染前、感染后 6 个月和 12 个月时使用与 STEC 疾病相关的问卷和用于 IBS（罗马 III）和心理因素的验证工具进行研究。应用频率和逻辑回归模型进行多重插补，以评估预测变量。
结果
IBS 的患病率从 STEC 感染前的 9.8%增加到感染后 6 个月的 23.6%和 12 个月的 25.3%。在 STEC 感染前无 IBS 症状的患者中，新发 IBS 的发病率为 16.9%。逻辑回归模型表明，更高的躯体化和焦虑评分是发生 IBS 的危险因素，而在 STEC 感染期间使用美沙拉嗪治疗则是 IBS 的唯一显著保护因素。未发现其他分析因素（包括疾病严重程度）与之相关。
结论
在这次异常严重的 STEC 爆发后，PI-IBS 的发生率与其他感染性胃肠炎爆发后观察到的发生率相似。我们的发现表明，美沙拉嗪可能降低了随后发生 PI-IBS 的风险。由于粘膜免疫活性改变是 PI-IBS 的关键致病因素，我们观察到美沙拉嗪可能具有潜在的保护作用，这可能是由于其对粘膜免疫的已知调节作用，值得进一步研究。
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