肠易激综合征患者在接受肠道导向催眠治疗前后的肠道微生物组。

UNLABELLED: Irritable bowel syndrome (IBS) is a disorder with brain-gut-microbiome alterations. Gut-directed hypnotherapy (GHT) has been shown to improve quality of life and symptoms in IBS. This therapy targets psychological coping, central nervous processing and brain-gut interaction. Studies have also demonstrated effects of hypnosis on intestinal transit and the mucosal immune system. So far, no study has examined the effect of GHT on the intestinal microbiome. This study aimed at examining microbial composition, IBS symptoms, and psychological distress before and after GHT. METHODS: Fecal samples were collected from 38 IBS patients (Rome-III criteria, mean age 44 years, 27 female, 11 male, 22 diarrhea-dominant, 12 alternating-type and 4 constipation-dominant IBS) before and after 10 weekly group sessions of GHT. Assessments in psychological (perceived stress, PSQ; psychological distress, HADS-D; quality of life, visual analogue scales) and IBS symptom-related variables (IBS severity, IBS-SSS; single symptoms, visual analogue scales) were performed with validated questionnaires. Fecal samples underwent microbial 16S rRNA analyses (regions V1⁻2). RESULTS: Microbial alpha diversity was stable before and after GHT (chao1 2591 ± 548 vs. 2581 ± 539, = 0.92). No significant differences were found in relative bacterial abundances but trends of reduced abundance of Lachnospiraceae 32.18 (4.14⁻39.89) Median (Q1⁻Q3) vs. 28.11 (22.85; 35.55) and Firmicutes: Bacteroidetes ratio after GHT were observable. Significant reductions in symptom severity (323 (266⁻371) vs. 264 (191⁻331), = 0.001) and psychological distress 17.0 (12.6⁻21.8) vs. 12.0 (8.3⁻18.0), = 0.001, and increased well-being were found after GHT. Adequate relief after therapy was reported by 32 (84%) patients. CONCLUSION: Reductions in IBS symptoms and psychological burden were observed after gut-directed hypnotherapy, but only small changes were found in intestinal microbiota composition. The findings suggest that hypnosis may act by central nervous impact and other factors largely independent from microbiota composition modulating the brain-gut axis, possibly alterations in vagus nerve functioning and microbiota metabolism.

目的：研究肠道导向催眠疗法（GHT）对肠易激综合征（IBS）患者肠道微生物群的影响。

方法：招募了 38 名 IBS 患者（罗马 III 标准，平均年龄 44 岁，27 名女性，11 名男性，22 名腹泻为主型，12 名交替型，4 名便秘为主型 IBS），在接受 10 周的 GHT 团体治疗前后，分别采集粪便样本。使用经过验证的问卷评估心理（感知压力，PSQ；心理困扰，HADS-D；生活质量，视觉模拟量表）和 IBS 症状相关变量（IBS 严重程度，IBS-SSS；单一症状，视觉模拟量表）。

结果：GHT 前后微生物 alpha 多样性稳定（chao1 2591 ± 548 vs. 2581 ± 539， = 0.92）。相对细菌丰度无显著差异，但可观察到 Lachnospiraceae 32.18（4.14-39.89）中位数（Q1-Q3）与 GHT 后 Firmicutes：Bacteroidetes 比值降低的趋势。GHT 后，症状严重程度（323（266-371）比 264（191-331）， = 0.001）和心理困扰 17.0（12.6-21.8）比 12.0（8.3-18.0）显著降低， = 0.001，并且幸福感增加。32 名（84%）患者报告治疗后症状缓解充分。

结论：肠道导向催眠治疗后 IBS 症状和心理负担减轻，但肠道微生物群组成变化较小。这些发现表明，催眠可能通过中枢神经系统的影响和其他因素起作用，而这些因素在很大程度上独立于调节脑-肠轴的微生物群组成，可能是迷走神经功能和微生物群代谢的改变。