感染后肠易激综合征与溃疡性结肠炎缓解期病人直肠黏膜细胞因子的论文鞠辉，王光兰，张海燕，赵清喜，魏良洲，刘希双 作者单位：青岛大学医学院附属医院, 山东 青岛 266003 内镜诊疗科; 消化内科【摘要】 目的 探讨感染后肠易激综合征（piibs）与溃疡性结肠炎（uc）缓解期病人肠黏膜细胞因子的表达，从神经免疫机制分析肠易激综合征（ibs）与炎症性肠病（ibd）的相关性。方法 piibs组病人20例，uc组病人45例，正常对照组30例，结肠镜下取直肠黏膜标本，采用免疫组化方法检测其肠黏膜细胞因子的表达情况。结果piibs病人直肠ifn、il2阳性表达高于对照组（2=、,p）。piibs病人直肠黏膜p物质（sp）强度均值高于对照组（t=,p）。直肠黏膜ifn、il2阳性表达的piibs病人sp强度均值高于对照组（t=、,p)。结论 piibs与ibd之间可能存在某种相关性。【关键词】 肠易激综合征；结肠炎,溃疡性；p物质；细胞因子类the incidence of functional disorder of intestine isabout 22%25% after the bowel is acutely infected. symptoms like ibs occur in some patients when the pathogens, such as enteric virus, bacterium or parasite, have been eliminated and the mucosal inflammation vanished, which is called postinfective irritable bowel syndrome (piibs)1. in remission, clinical manifestations of uc often resemble irritable bowel like syndrome (ibls), which is characterized by abdominal pain and diarrhea without gastrointestinal tract and biochemical abnormality. the therapeutic efficacy is not satisfactory with aminosalicylic acid alone2. a followup study of the patients with initial diagnosis of ibs indicated that they were at obviously high risk of developing ibd, with a relative risk being , which suggestive of certain correlation really exists between ibs and ibd3. the purpose of this study was to investigate the expressions of sp, ifn and il2 in rectal mucosa of patients with piibs and uc in remission, analyze the association between ibs and ibd based on neuroimmunomechanism.1 materials and methodscase selectionaccording to rome criteria 4, 45 diarrheaibs patients, 17 men and 28 women, the mean age was years, were randomly recruited from outpatient clinic of gastroenterology at the affiliated hospital of qingdao university medical college. of whom, 20 were classified as piibs meeting the romecriteria, with a history of acute gastrointestinal tract infection at least one day before appearing ibs symptoms, cured within five days and relapsefree. fortyfive uc patients in remission， 25 men and 20 women, mean age was years. the standards of enrolment were: with a history of uc diagnosed enteroscopically, with symptoms of abdominal pain and diarrhea similar to ibs but without abnormalities of the structure and biochemistry of digestive tract, no obvious signs of congestion, edema or exudation were observed at enteroscopy, and poorly responded to aminosalicylic acid alone. thirty controls, 12 men and 18 women, mean age was years. the standards of enrolment were: at least six months after electroresection of colon polyp and no abnormalities were noticed at followup or coloscopic diagnosis as having hemorrhoid due to slight bloody stools, with no other symptoms and signs of digestive tract. no history of immunologically mediated disease or infection and no recent medication were recorded.methodstwo pieces of rectal mucosa were taken in each case, fixed in10% formalin, and embedded in paraffin. a 4m thick serial section was made for all paraffin blocks. he staining, routine pathohistological and immunohistochemical examinations were conducted. with an assistance of a senior pathologist, typical areas not including the margins from every section were chosen to judge the dyeing of ifn and il2. the results were graded via positive cell percentage and dyeing intensity and the scores were determined according to cytoplasm coloration5. the absorbance was detected for sp quantitative analysis with vidas picture analysis system. the results were analyzed by variance analysis and t test with spss statistical pack.2 resultsin the he dyed sections, the rectal mucosa of piibs and uc patients was integrity, a few lymphocyte and plasma cell infiltration could be seen in submucosa and intrinsic glands, the differences were not significant as xxpared with the controls.expressions of ifn and il2ifn and il2 expressed in lamina propria of the rectal mucosa, appearing as buffy in color, and distributing around the glands. the respective positive expression rates of ifn and il2 of piibs were % and %; of uc were % and %; of controls were % and %. the positive expressions of ifn and il2 in piibs were higher than those of the controls (2=,;p）.expression of spsp was expressed in the propria around the glands, in the form of scattering points or clusters. the intensity of sp in rectal mucosa of piibs, uc and controls was , and , respectively, which was higher in piibs than that of the controls (t=,p). sp intensity in uc was higher than that of the controls (t=,p）.3 discussionibs differs from ibd. recent studies, however, indicate that they have many similarities in symptoms and mechanisms, and the risk of ibs developing into ibd increases. bercik p et al6 proposed that ibs may be the lower grade of ibd. the occurrence of ibs and ibd and exacerbation of their symptoms are probably associated with bowel i